THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


HOME  HYGIENE  AND 
PREVENTION  OF  DISEASE 


HOME  HYGIENE  AND 
PREVENTION  OF  DISEASE 


BY 
NORMAN  E.  DITMAN,  M.D. 


NEW  YORK 

DUFFIELD  &  COMPANY 
1912 


Copyright  1912,  by 
DUFFIELD  &  COMPANY 


INTRODUCTION 

One  of  the  most  important  developments  of  modern  medi- 
cine has  been  the  fact  that  it  is  now  realized  that  it  is  far 
better  to  avoid  than  to  contract  illness,  even  if  the  modern 
methods  of  treatment  have  robbed  disease  of  many  of  its 
old-time  terrors.  A  consequence  of  this  has  been  that  the 
modern  physician  takes  every  opportunity  to  instruct  his 
clientele  how  to  avoid  contracting  disease. 

It  is  with  a  belief  that  this  part  of  the  physician's  in- 
structions can  be  advantageously  supplemented  with  infor- 
mation which  the  average  person  can  have  constantly  at 
hand  that  has  made  the  publishing  of  this  book  seem  dis- 
tinctly called  for.  Simple  as  a  physician 's  advice  may  seem 
for  the  avoidance  of  any  disease,  it  is  often  necessary  to 
have  this  advice  in  a  form  where  it  can  be  more  carefully 
studied  and  digested  if  we  are  to  develop  a  "hygienic 
sense"  which  will  enable  us  more  or  less  instinctively  to 
avoid  the  paths  which  lead  to  disease. 

The  public  as  a  class  has  been  saved  much  suffering  and 
avoidance  of  future  inconvenience  by  the  knowledge  which 
it  has  assimilated  on  first  aid  to  the  injured.  Similar  bene- 
fit should  result  from  popular  appreciation  of  the  methods 
of  first  aid  to  the  sick.  For  often,  in  the  case  of  illness  * '  a 
stitch  in  time  saves  nine. ' ' 

One  justification  of  a  popular  work  of  this  kind  is  that 
not  only  can  its  readers  render  the  best  aid  to  the  incipient 
or  slight  invalid;  but  they  should  be  enabled  to  better 
appreciate  when  an  ailment  has  become  serious  enough  to 
require  expert  medical  attendance,  or  when  a  disease  is 
from  the  outset  beyond  the  aid  of  unskilled  hands. 

There  are  few  in  our  modern  era  of  civilization  who  do 
not  understand  the  workings  and  failings  of  automobiles, 
engines,  phonographs,  sewing  machines  and  household  ap- 
pliances. It  would  seem  the  part  of  discretion  therefore 
if  we  knew  at  least  as  much  about  a  few  of  the  commoner 
workings  and  failings  of  the  human  body — a  machine  of 


INTRODUCTION 

far  more  importance  to  all  of  us  than  all  the  mechanical 
appliances  in  the  world. 

It  is  with  this  purpose  in  view  that  the  author  of  this 
work  ventures  to  place  it  in  the  hands  of  the  public,  ex- 
pressing, at  the  same  time,  the  hope  that  some  of  the  more 
technical  of  the  information  imparted  will  be  employed 
with  discretion.  To  those  living  in  rural  districts  where 
the  service  of  physicians  is  difficultly  obtainable  it  is  hoped 
that  the  information  herein  contained  will  be  a  means  of 
saving  life  and  avoiding  unnecessary  suffering.  To  those 
living  less  far  from  the  trodden  highways  it  is  hoped  this 
work  will  prove  to  be  an  aid  to  the  physician — educating 
the  human  kind  to  a  more  intelligent  appreciation  of  his 
efforts,  lessening  the  numberless  irritations  and  infinite 
inconvenience  resulting  from  the  human  gad-fly  "minor 
ailments";  and  materially  lightening  the  load  of  long- 
suffering  humanity  from  preventable  sickness. 

In  many  cases  it  is  difficult  to  judge  from  a  patient's 
symptoms  the  precise  character  of  the  disease  from  which 
he  is  suffering,  and  it  is  obvious  that  except  in  the  simplest 
cases  no  one  but  a  medical  man  can  form  a  reliable  opinion. 
It  must  be  made  clear  that  the  object  of  this  book  is  not  to 
displace  the  family  doctor,  but  to  furnish  the  reader  with 
general  information  regarding  medical  subjects;  and  that 
while  pains  have  been  taken  to  ensure  accuracy,  the  author 
and  publishers  can  accept  no  responsibility  for  errors. 
Nearly  all  the  medicines  mentioned  in  the  text  (except 
those  marked  POISON)  may  be  obtained  from  licensed  drug- 
gists without  the  prescription  or  signature  of  a  medical 
man,  but  persons  who  treat  themselves  in  accordance  with 
the  directions  contained  in  the  book  must  realize  that  they 
do  so  on  their  own  responsibility. 

N.  E.  D. 


HOME  HYGIENE  AND 
PREVENTION  OF  DISEASE 


HOME  HYGIENE  AND  PEEVENTION 
OF  DISEASE 


Abscess, — When  some  part  of  the  body  is  damaged  by 
injury  or  poisoned  by  a  germ,  inflammation  is  set  up,  and 
the  symptoms  of  heat,  redness,  swelling,  and  pain,  begin  to 
appear.  If  the  supply  of  good  blood  is  sufficient  to  over- 
come the  poison  or  to  repair  the  damage  done,  then  the 
inflammation  grows  less  and  less  until  at  last  the  mischief 
is  as  far  repaired  as  ever  it  can  be.  But  if  the  poison  is 
too  strong,  or  the  damage  too  severe,  then  the  inflammation 
increases  in  intensity,  until  there  is  formed  a  swelling  which 
has  in  the  middle  of  it  an  isolated  collection  of  dead  blood- 
cells,  constituting  what  we  call  "matter,"  or  "pus,"  sur- 
rounded by  a  red  ring  of  inflammation.  The  results  of  the 
struggle  between  the  blood  and  the  poison  are  thus  walled 
in  so  that  they  cannot  do  much  more  damage,  and  this 
state  of  the  part  is  called  an  abscess. 

If  possible  we  try  to  avoid  the  formation  of  an  abscess, 
either  by  destroying  the  bacteria  causing  the  trouble,  by 
helping  the  inflammation  or  by  relieving  the  process  by 
cutting  into  it  and  washing  out  the  poison. 

The  first  may  be  accomplished  by  applying  wet  dressings 
composed  of  sterile  gauze  saturated  with  a  solution  of  bi- 
chloride of  mercury  (1-2000)  or  aluminium  acetate. 

The  inflammation  may  sometimes  be  helped  by  causing 
an  increased  flow  of  blood  to  *  he  part  by  applying  a  vacuum 
cup.  Warm  applications  may  hasten  the  formation  of  an 
abscess,  but  when  an  abscess  has  once  formed  the  sooner  it 
is  opened  the  better.  If,  on  looking  at  an  inflamed  swell- 
ing, you  can  see  a  yellowish  spot  anywhere,  then  the 
swelling  has  become  an  abscess,  and  ought  to  be  opened  at 
once,  and  the  pus  let  out. 

Nowadays  the  fear  of  the  surgeon's  knife  is  unnecessary. 
A  doctor  will  always  save  the  patient  pain  by  using  some 


2  ACNE 

anaesthetic  to  deaden  the  feeling  in  the  part.  (See  "Anaes- 
thetics.) And  the  sooner  the  cutting  is  done  the  smaller 
will  be  the  scar,  and  the  sooner  the  whole  trouble  will  be 
over. 

Acidity  (Sour  Stomach,  Heartburn). — This  is  not  a  disease 
in  itself,  but  merely  one  of  the  symptoms  of  indigestion  or 
dyspepsia.  It  is  a  sign  that  either  too  much  food  is  being 
taken,  more  than  can  be  thoroughly  digested,  or  that  there 
is  something  radically  wrong  with  the  digestive  process — 
that  is,  with  the  kind  of  food  taken.  A  change  is  needed. 
Not  that  you  must  go  away  to  the  seaside,  but  that  you 
must  alter  your  mode  of  living,  eating,  and  drinking.  The 
sour  taste  in  your  mouth,  the  feeling  of  weariness  after  a 
night's  rest,  the  dream-harassed  slumber — all  these  may  be 
removed  by  simple  means.  First,  get  your  teeth  attended 
to,  so  that  the  food  may  be  properly  chewed.  Then,  have 
your  meals  at  stated  intervals  punctually.  Avoid  all 
spirituous  liquors,  drink  only  at  the  end  of  a  meal,  avoid 
too  much  meat,  and  pastry,  and  cheese,  and  pickles;  and 
take  a  teaspoonful  of  bicarbonate  of  soda  and  a  teaspoonful 
of  carbonate  of  magnesia  in  a  tumbler  of  water  every  night 
at  bedtime.  In  addition,  go  to  bed  early,  rise  early,  take 
plenty  of  exercise,  and  your  "sour  stomach"  will  soon  be 
only  a  memory  of  a  disagreeable  past.  (See  also  "Indi- 
gestion/') 

(1)  For  acidity  and  sour-smelling  diarrhea  in  children 
under  10: — Sodium  bicarbonate,  2  grains;  mercury  and 
chalk,  2  grains ;  magnesium  carbonate,  5  grains.     (Mix  and 
make  a  powder  to  be  taken  every  other  night. ) 

(2)  For   acidity,    heartburn   and   painful   digestion: — 
Liquor  of  bismuth,  1  drachm ;  infusion  of  quassia,  1  ounce. 
(This  draught  to  be  taken  three  times  every  day.) 

(3)  Powders  for  acidity  and  heartburn : — "White  bismuth, 
10    grains;    magnesium   carbonate,    10    grains.     (Make    a 
powder  to  be  taken  in  half  a  bottle  of  soda  water  twice  a 
day.) 

Acne.—  (See  "Blackheads.")  The  little  pores  and  fol- 
licles in  the  skin  sometimes  get  blocked  up  by  dirt,  and  as 
described  under  "Blackheads,"  there  remain  little  tiny 
pouches  of  fatty  matter,  which  can  be  squeezed  out  by 
pressure  with  a  key,  or  by  the  finger-nails.  Sometimes  the 
dirt  which  blocks  the  entrance  to  the  pores  remains  fixed 
in  the  tubes,  and  then  the  blackheads  become  red  and  in- 


ADENOIDS  3 

flamed  and  are  called  acne  spots.  These  pustules,  or  small 
abscesses,  presently  come  to  a  head,  and  then  burst,  dis- 
charging matter.  This  matter — pus — is  poisonous,  and  if 
carried  by  scratching  finger-nails  to  another  part  of  the 
skin,  causes  fresh  acne  spots  there.  Acne  spots  leave  un- 
sightly scars.  In  older  people  a  variety  of  "acne"  is  apt 
to  appear  on  the  nose,  especially  on  the  red  shiny  nose  of 
the  alcoholic  drunkard. 

Treatment. — In  young  people  too  much  smoking,  and  in- 
digestion due  to  bolting  the  food  are  the  general  causes  of 
the  complaint.  The  first  and  last  of  the  treatment  is 
summed  up  in  the  word  cleanliness.  The  skin  must  be  kept 
very  clean  indeed,  not  only  by  frequent  washing,  but  by 
rubbing  violently  with  rough  towels  after  the  washing. 
The  rubbing  makes  the  skin  red,  and  that  is  what  is  wanted, 
for  the  increase  of  blood  improves  the  nourishment  of  the 
skin  and  helps  it  to  fight  against  the  evil  effects  of  dirt  and 
germs. 

Thin  people  with  acne  ought  to  take  cod-liver  oil,  and  fat 
ones  should  drink  a  purgative  mineral  water,  or  take  a 
Seidlitz  powder  every  morning.  When  the  acne  pustules 
are  already  formed,  steam  the  skin,  and  clean  it  well  with 
friction  and  soap,  and  then,  using  a  new  needle,  prick  the 
yellow  point  in  each  spot  and  squeeze  out  the  pus,  and  wipe 
it  away  with  a  cloth  dipped  in  peroxide  of  hydrogen. 
Then  bathe  the  skin  well,  and  rub  in  white  lotion.  This 
may  be  reapplied  several  times  during  the  day. 

All  the  cotton-wool,  gauze  or  lint  which  has  been  used 
is  to  be  burnt,  and  the  needle  also.  And  the  hands  should 
be  washed,  and  the  nails  scrubbed,  with  carbolic  soap. 

Adenoids. — Adenoids,  or,  properly  speaking,  "adenoid 
vegetations, ' '  are  overgrowths  of  the  glandular  tissue  which 
is  found  in  the  back  of  the  upper  part  of  the  throat,  just 
where  the  nasal  cavity  opens  behind.  They  are  allied  to 
the  enlarged  glands  which  are  so  common  about  the  angles 
of  the  jaws  in  children  and  in  their  necks ;  and  their  pres- 
ence causes  a  great  susceptibility  to  catching  cold.  The 
adenoids,  if  plentiful,  block  up  part  of  the  passage  through 
which  breathing  takes  place  and  prevent  the  proper  de- 
velopment of  the  lungs.  Not  only  that,  but  they  cause 
deafness.  About  ninety  per  cent,  of  all  the  cases  of  deaf- 
ness among  children  are  due  to  adenoids.  Children  with 
adenoids  generally  look  stupid,  keep  the  mouth  open,  and 


4  AGE  AND  WEIGHT 

breathe  through  it,  and  are  listless  and  lack  concentration. 
Lastly,  such  children  are  often  nervous  and  irritable  and 
are  prone  to  bed-wetting  and  to  have  nightmares. 

Treatment. — If  the  child  cannot  sleep  with  its  mouth 
shut,  or  play  without  getting  out  of  breath,  the  adenoids 
ought  to  be  removed  by  operation.  There  is  nothing  else 
of  any  use. 

Age  and  Weight. — The  proper  relations  between  age  and 
weight  are  shown  in  the  following  tables ;  which,  however, 
are  not  to  be  taken  as  representing  an  invariable  standard. 
Many  persons  of  less  weight  than  is  here  shown  enjoy  ex- 
cellent health. 


I.—  CHILDREN. 


Years  of 
age 

Boys 

Girls 

Ibs. 

Ibs. 

5 

50 

40 

6 

54 

43 

7 

57 

48 

8 

60 

52 

9 

64 

57 

10 

69 

62 

11 

73 

69 

12 

79 

78 

13 

84 

89 

14 

92 

98 

15 

103 

106 

II.—  ADULTS. 


Male 

Female 

Height 

Weight 

Height 

Weight 

ft.    in. 

Ibs. 

ft.    in. 

Ibs. 

5     2 

126 

4    10 

98 

5     3 

133 

4    11 

102 

5     4 

139 

5     0 

105 

5     5 

142 

5     1 

110 

5     6 

145 

5     2 

114 

5     7 

148 

5     3 

121 

5     8 

155 

5     4 

128 

5     9 

162 

5     5 

135 

5    10 

169 

5     6 

139 

5    11 

174 

5     7 

148 

6     0 

178 

5     8 

158 

ALCOHOLIC  DRINKS  5 

Alcohol,  Acute  Poisoning  by.— When  spirits  are  given  to 
children,  or  when  adults  go  in  for  a  debauch  and  drink 
excessive  quantities  of  alcoholic  liquors,  the  alcohol  acts 
as  a  deadly  poison  and  sometimes  kills  on  the  spot. 

If  death  does  not  occur,  the  drinker  to  excess  becomes 
more  or  less  collapsed,  his  muscles  are  relaxed  and  he  lies 
helpless  and  perhaps  insensible.  If  left  in  this  state  he 
may  sink  and  die,  or  he  may  perhaps  sleep  it  off,  or  he 
may  catch  inflammation  of  the  lungs  and  die  of  that  in  a 
very  short  time.  The  treatment  is  to  empty  the  stomach 
first ;  give  a  drink  of  warm  mustard  and  water.  When  the 
doctor  comes  he  will  probably  give  a  stronger  emetic,  if 
the  mustard- water  has  not  yet  acted,  and  then  will  ad- 
minister hot,  strong  coffee  injections  into  the  rectum  (or 
back  passage)  with  a  Higginson  syringe,  and  rouse  the 
patient  by  every  possible  means.  Later  on  the  sick  man 
will  require  a  long  rest  and  plenty  of  liquid  nourishment. 

The  delirium,  which  sometimes  comes  on  at  the  end  of  a 
long  spell  of  drinking,  and  which  is  known  as  "D.T.'s"  or 
Delirium  Tremens,  may  be  fatal  after  a  few  hours  of  horri- 
ble suffering  and  mental  agony.  Careful  and  constant 
nursing  is  required,  sleep  and  plenty  of  food.  These  cases 
should  be  treated  by  a  doctor. 

Alcoholic  Drinks,  Moderation  in. — The  writer  pleads  for 
moderation  in  the  drinking  of  alcohol,  as  in  all  things  else 
— for  conscience  sake,  for  the  stomach's  sake  and  for  the 
sake  of  society,  the  comfort  and  well-being  of  which  all 
are  bound  to  consider. 

Probably  never,  throughout  the  world's  history,  has  been 
seen  so  widespread  and  drastic  a  movement  against  the 
use  of  alcoholic  drinks  as  the  modern  so-called  Temperance 
Movement ;  so-called  because  the  most  of  the  reformers  aim, 
not  at  "temperance,"  which  means  moderation,  but  at 
total-abstinence.  It  cannot  be  denied  that  there  is  much 
that  is  admirable  in  this  movement  in  a  time  of  excessive 
drinking,  and  that  the  motives  of  the  promoters  are  lofty 
and  command  respect.  Seeing  around  them  the  millions 
who  are  being  made  unhappy,  unhealthy,  criminal,  or  mad, 
by  excess  of  alcohol,  the  total  abstainers  are  teaching  that 
even  the  moderate  use  of  alcohol  is  full  of  danger,  and  that 
everyone  owes  it  to  himself  to  give  up  every  form  of  it. 
The  last  word  of  science  up-to-date  is  definitely  on  the  side 
of  the  reformers,  and  against  alcohol  even  in  moderation. 


6  ALCOHOLIC  DRINKS 

"Even  the  smallest  doses,"  says  the  scientist,  "lessen 
energy  and  efficiency  to  some  extent,  and  have  the  in- 
evitable reaction  of  depression."  These  truths  are  pretty 
generally  known  by  this  time,  and  if,  in  consequence,  all 
who  dearly  value  their  health  do  not  at  once  become  total 
abstainers,  it  is  probably  because  they  realize  that  most 
people  have  funds  of  health  and  energy  within  them,  far 
greater  than  are  required  in  the  mere  daily  routine  of  life ; 
and  they  are  of  opinion,  too,  that  with  that  superfluity  of 
energy  they  ought  to  be  allowed  to  do  as  they  please.  To 
be  a  lifelong  total  abstainer  means  to  be  quite  safe  from  a 
host  of  diseases — to  be  on  the  safe  side  entirely  as  regards 
the  diseases  due  to  alcohol.  It  means  never  to  be  brain- 
fuddled,  never  to  be  sentimentally  maudlin ;  easily  to  avoid 
being  grossly  impure  or  vicious;  or  at  any  time  entirely 
at  the  mercy  of  ruffianly  men  or  scheming  and  evil  women ; 
and  lastly,  it  means  to  save  much  money  which  would 
otherwise  be  spent  on  the  vices  which  seem  to  be  insepara- 
ble from  excessive  indulgence.  And  the  really  healthy 
youth,  starting  in  life  with  an  equable  commonplace  tem- 
perament, a  fair  knowledge  of  the  possible  evils  of  drunken- 
ness, and  no  drinking  companions  to  prompt  him,  would 
almost  certainly  prefer  to  do  without  alcohol  altogether, 
and  would  go  on  his  way  rejoicing,  healthy,  happy  and 
sober-minded — even  if  a  bit  of  a  prig. 

The  moderate  drinker,  on  the  other  hand,  desirous  of  an 
occasional  emotional  excitement  in  the  dull  routine  of  life, 
lives  in  a  different  set  of  circumstances.  He  knows,  or 
may  know,  of  loftier  flights  of  imagination  (as  well  as 
deeper  depths  of  depression)  than  the  teetotaler;  he  has 
generally  more  sympathy  with  the  poor,  the  afflicted,  and 
the  tempted,  than  the  total  abstainer,  who  is  too  apt  to  be 
self-righteous.  Among  the  moderate  drinkers  have  been 
some  of  the  world's  greatest  men  and  most  honored  names. 

All  the  serious  disadvantages  of  alcohol  are  connected 
with  its  abuse;  it  would  be  ignorant  and  foolish  to  deny  the 
advantages  of  its  use.  Just  as  a  tired  horse  at  the  sound 
or  touch  of  the  whip  makes  a  grand  effort  to  complete  its 
task,  despite  fatigue,  so  will  a  man  or  woman  sometimes 
overcome  a  serious  difficulty  by  the  help  of  the  stimulus 
supplied  by  alcohol. 

The  great  majority  of  mankind  in  every  land  have  al- 
ways used  alcohol,  more  or  less  in  moderation;  the  general 


ALCOHOLIC  DRINKS  7 

feeling  everywhere  has  been  always  against  the  abuse  of 
it.  Hence  arises  the  question,  so  very  difficult  for  the 
individual  to  solve — "What  is  moderation?" 

We  have  all  of  us  seen  plenty  of  examples  of  men  and 
women  of  advanced  age,  who  are  in  good  health,  and  who 
are  known  to  have  drunk  beer,  cider,  wine  or  spirits  all 
their  lives ;  so  that  there  can  be  no  doubt  that  it  is  possible, 
for  some  of  us  at  any  rate,  to  enjoy  the  benefits  of  alcohol 
in  moderation,  and  to  reach  a  healthy  old  age. 

Now  all  alcoholic  beverages  produce,  in  moderate  doses 
and  well  diluted,  a  certain  pleasurable  effect  called  stimu- 
lation. If  the  majority  of  alcoholic  drinks  were  not  as 
shamefully  adulterated  as  they  undoubtedly  are,  people 
would  find  that  the  stimulant  effect  came  sooner  and  with 
smaller  quantities,  and  that  the  after-effects  are  less  dis- 
agreeable. It  is  the  cheap  adulterated  rubbish  that  nearly 
every  publican  sells  so  much  of  to  the  poor  which  does 
harm  to  those  who  honestly  desire  moderation.  The  drink 
manufacturer  makes  large  profits,  and  almost  in  every  case 
adds  something  to  the  liquor  he  sells  to  increase  the  thirsti- 
ness  of  the  customer.  No  wonder  moderation  is  difficult 
to  maintain. 

By  a  "  stimulant "  effect  we  mean  a  sense  of  well  being, 
an  elation,  a  hopefulness,  warmth,  and  good  humor.  The 
same  small  dose  gives  appetite,  increases  the  rate  of  the 
pulse,  and  supplies,  sometimes,  fresh  energy  for  a  disagree- 
able task. 

Now,  every  stimulant  effect  has  a  corresponding  period 
of  depression.  This  will  be  noticed,  perhaps,  an  hour  after- 
wards, and  may  last  an  hour  or  two ;  or  the  period  may  be 
spent  in  sleep,  when  the  depression  passes  unnoticed  and 
recuperation  takes  place  as  well. 

When  a  hard  task  has  to  be  long  continued,  even  a  small 
dose  of  alcohol  does  more  harm  than  good,  and  to  repeat 
the  dose  will  do  even  more  harm.  After  a  long  task  is 
completed  a  dose  of  alcohol  is  comforting,  sedative  and 
refreshing  and  promotes  the  sleep  that  is  so  greatly  needed. 
One  thing  is  certain,  namely,  that  alcohol  does  not  confer 
any  additional  working  power.  It  may  give  a  temporary 
stimulus  to  body  work  or  brain  work,  but  reaction  succeeds, 
and  leaves  the  body  and  mind  less  active  than  before. 

We  come  then,  to  this  conclusion,  that  the  greatest  diffi- 
culty, as  regards  moderate  drinking,  lies  in  the  fact  that 


8  ANAEMIA 

just  as  no  two  persons  are  alike  in  size,  weight,  constitution 
or  appetite,  so  the  quantity  of  alcoholic  liquor  which  will 
help  one  man  and  do  him  no  harm,  repeated  daily  for  years, 
may  entirely  ruin  a  man  who  has  weak  organs  or  some  dis- 
ease of  the  heart,  liver,  or  kidneys.  What  may  be  modera- 
tion in  you  may  lead  to  my  early  death.  How  then  is  a 
person  to  judge  whether  he  may  take  any  alcohol  or  not, 
and  how  much,  and  how  often? 

The  answers  are,  after  all,  fairly  definite.  Drink  none 
at  all  if  you  desire  perfect  safety,  and  especially  if  any 
relations  or  ancestors  of  yours  were  of  drunken  habits.  If 
you  will  drink,  drink  as  little  as  you  can,  especially  if  your 
life  is  sedentary  and  you  cannot  get  much  exercise.  Drink, 
in  any  case,  only  at  meal  times,  and  you  will  not  go  far 
wrong.  Set  your  face  against  the  senseless  parrot  cry, 
''Come  and  have  a  drink,"  and  the  foolishness  of  creating 
an  artificial  thirst,  which  leads  to  the  benefit  of  one  person 
only — the  drink-seller.  It  is  natural  and  proper  for  young 
people  to  like  convivial  society,  but  the  society  of  the  public- 
house  bar  has  nothing  to  recommend  it.  Young  women  do 
not  find  it  necessary  to  be  continually  taking  nips  of  alcohol 
to  bring  out  their  wit  and  gayety,  and  young  men  would  do 
well  to  bear  the  fact  in  mind.  There  is  nothing  "manly" 
in  the  silly  sleepiness,  or  the  bubbling  frothy  gayety  in- 
duced by  too  many  drinks.  Directly  you  feel  the  stimulus 
of  the  first  drink,  alcohol  has  done^  all  the  good  in  its  power, 
and  more  alcohol  does  harm.  It  is  when  the  stimulation  is 
felt,  of  course,  that  there  is  the  greatest  temptation  to 
secure  some  more,  and  then  begins  the  poisoning  of  the 
system  and  the  overworking  of  the  liver  and  kidneys. 
Actual  experiment  has  shown  that  from  1  ounce  to  1% 
ounces  of  absolute  alcohol  represents  the  quantity  of  alco- 
hol which  a  healthy  man  may  daily  consume  without  ill 
effects.  (See  also  "Beverages.") 

Anaemia. — Ancemia  means  bloodlessness,  but  nobody  is 
bloodless,  and  so  the  word  is  used  to  mean  any  state  of 
health  in  which  the  blood  is  not  of  as  good  a  quality  as  it 
should  be.  The  pink  color  of  the  lips  and  other  "mucous 
membranes"  is  due  to  the  red  color  of  the  blood  which 
circulates  under  the  surface  of  them.  A  person  may  be 
anemic  (or  poor  blooded)  because  he  has  lost  a  quantity 
of  blood  by  accident,  or  because  he  is  badly  nourished,  or 
because  he  is  poisoned  by  some  disease,  or  chemical  poison 


ANAEMIA  9 

such  as  lead.  Or  he  may  be  anaemic  because  his  blood- 
making  powers  are  not  up  to  the  mark.  We  shall  describe 
only  the  more  common  forms  of  anaemia,  such  as  is  not 
caused  by  loss  of  blood. 

1. — CHLOROSIS  or  Green  Sickness.  This  is  the  anaemia 
so  common  in  young  girls  about  13  or  14  years  of  age.  In 
a  bad  case  of  this  kind  of  anaemia,  the  girl  looks  pale,  or 
yellowish  and  sallow-tinted,  her  lips  pale  pink,  her  cheeks 
a  little  flushed.  On  the  backs  of  the  hands  the  veins  show 
pink  through  the  whitish  skin  instead  of  purplish  through 
a  pink  skin.  She  is  languid,  weak  and  tired,  and  is  liable 
to  headaches,  giddiness,  fainting-fits,  shortness  of  breath 
on  going  upstairs,  and  swollen  ankles  at  bedtime.  Her 
appetite  is  poor  and  she  complains  of  a  feeling  of  a  heavy 
weight  on  the  chest  after  meals.  At  the  same  time,  she 
may  be  fat,  or  at  any  rate  plump.  Such  girls  are  very 
often  emotional  and  hysterical  (see  "Hysteria")  and  full 
of  sentimental  sickly  fancies.  They  nearly  always  have 
some  disturbance  of  the  female  functions;  very  often  in 
anaemia  the  courses  stop  altogether,  and  the  girl  grows 
irritable  and  apt  to  shut  herself  up  or  moon  about  alone. 

Treatment. — This  may  be  summed  up  in  a  sentence. 
Take  iron  and  keep  the  bowels  freely  open.  Iron,  in  some 
form  or  another,  will  have  to  be  taken  continuously  for 
three  months  or  more.  Iron,  if  given  in  large  doses  and 
often  enough,  will  cure  nearly  all  cases.  But  even  iron 
is  useless  unless  the  bowels  are  kept  freely  open.  This  is 
Sir  Andrew  Clark's  medicine  for  chlorosis,  and  it  will  be 
found  suitable  for  a  large  number  of  cases,  though  not  for 
all:- 

Sulphate  of  magnesium,  6  drachms ;  sulphate  of  iron,  24 
grains;  aromatic  sulphuric  acid,  1  drachm;  tincture  of 
ginger,  2  drachms;  compound  infusion  of  gentian,  to 
8  ounces — a  sixth  part  to  be  taken  twice  a  day. 

2. — ANAEMIA  in  Adults.  The  treatment  of  this  must  de- 
pend upon  the  cause  of  it.  Lead-poisoning  (see  "Lead- 
Poisoning"),  gout,  syphilis,  kidney-disease,  malaria,  severe 
bleeding  piles,  discharges,  stomach  inflammations — all  these 
may  be  causes  of  anaemia. 

Iron,  given  in  some  form  which  will  not  upset  digestion, 
is  the  real  cure  for  anaemia.  To  begin  treatment  the  pa- 
tient must  take  a  smart  purge  of  Epsom  salts,  then  continue 


10  ANEURISM 

with  iron  and  a  bitter  tonic  like  quinine.  Thus — Tincture 
of  perchloride  of  iron,  10  fluid  drachms;  sulphate  of  qui- 
nine, 1  drachm,  20  grains;  glycerine,  2  fluid  ounces;  water 
to  8  fluid  ounces.  Take  two  teaspoonfuls  of  this  mixture 
in  a  wineglassful  of  water  thrice  daily  after  meals. 

Persons  who  are  very  weak  as  well  as  anaemic  may  find 
the  following  pill  very  useful : — To  make  one  pill — Arseni- 
ate  of  iron,  a  quarter  of  a  grain;  reduced  iron,  5  grains. 
Take  one  pill  morning  and  evening  after  meals. 

One  of  the  most  widely  used  of  all  iron  preparations  in 
the  treatment  of  anaemia  is  Blaud's  pill  in  combination 
with  cascara  or  some  other  laxative.  There  is  another 
form  of  anaemia  known  as  pernicious  anaemia  which  is  diffi- 
cultly curable  and  which  may  terminate  in  death.  There- 
fore in  the  case  of  any  anaemia  which  does  not  respond 
readily  and  quickly  to  the  ordinary  modes  of  treatment 
for  anaemia,  a  good  physician  should  be  quickly  consulted. 

Anaesthetics. — This  is  the  word  which  means  all  the 
different  medicines  used  to  send  people  to  sleep — the  arti- 
ficial sleep  and  insensibility  to  pain,  called  anaesthesia. 
The  art  of  using  anaesthetics  is  now  so  well  understood  that 
no  one  need  be  afraid  of  them.  A  very  few  deaths  occur 
every  year  from  anaesthetics  in  the  case  of  people  with 
unsuspected  bad  heart  disease  or  broken-down  constitu- 
tions. 

The  chief  drugs  used  are  ether,  chloroform  and  nitrous 
oxide  gas  for  producing  artificial  sleep,  and  cocaine,  eu- 
caine  and  ethyl  chloride  to  produce  insensibility  of  the 
skin.  The  choice  of  anaesthetic  must,  of  course,  be  left 
entirely  to  the  judgment  of  an  expert,  but  as  a  matter  of 
fact  there  are  almost  no  cases  of  illness  (in  which  an  opera- 
tion is  really  required),  for  which  a  suitable  anaesthetic  can- 
not be  found. 

Aneurism. — Inside  the  blood  vessels,  of  course,  there  is 
always  a  great  pressure  of  blood,  caused  every  moment  by 
the  beating  of  the  heart,  which  pumps  blood  round  the 
whole  body.  The  pressure  is  great,  and  the  blood  vessels 
(arteries  and  veins)  have  to  bear  it  without  giving  way. 
This  they  could  not  do  unless  they  were  elastic,  as  in  fact 
they  are.  The  arteries  are  elastic  tubes,  dilating  when 
more  blood  rushes  through  them,  and  contracting  when 
there  is  less  blood.  An  artery  never  ruptures,  even 
when  the  heart  is  beating  furiously,  so  long  as  it  retains  its 


ANTISEPTICS  11 

elasticity.  But  in  old  age  the  arteries  become  less  elastic, 
less  able  to  cope  with  sudden  alterations  of  pressure,  and 
the  same  thing  happens  even  in  youth  in  the  presence  of 
such  diseases  as  gout,  syphilis,  and  alcoholism.  The  weak- 
ening of  the  arteries  in  these  diseases  may  affect  all  the 
blood  vessels  of  the  body,  or  only  certain  of  them,  or  some- 
times only  small  patches  on  a  very  few  of  them.  This 
disease  of  the  arteries  is  called  atheroma,  and  everyone 
with  atheromatous  arteries  who  is  subjected  to  physical 
strain  or  hard  manual  labor,  is  liable  to  have  an  aneurism. 
An  aneurism  is  a  blood-tumor  connected  with  an  artery 
and  caused  by  the  weakened  inner  wall  of  the  artery  di- 
lating and  giving  way  before  suddenly-increased  pressure 
of  blood.  Once  an  aneurism  is  formed,  it  has  a  slight 
tendency  to  self-cure,  and  will  get  well  spontaneously  if 
suitable  medical  treatment  and  nursing  can  be  obtained. 
Of  course,  the  signs  and  symptoms  of  an  aneurism  depend 
altogether  on  the  position  of  it — it  may  be  behind  the  knee, 
in  the  chest,  in  the  lungs,  in  the  abdomen,  or  almost  any- 
where else.  The  symptoms  are  always  pain,  more  or  less, 
and  the  results  of  the  pressure  on  other  organs.  Nothing 
more  can  be  said  here  about  aneurisms ;  they  are  in  no  way 
suited  for  home-doctoring,  and,  in  fact,  often  tax  the  in- 
genuity and  skill  of  the  cleverest  and  most  experienced 
medical  man. 

Angina  Pectoris,  or  BREAST  PANG,  is  a  sudden  cramp  of 
the  heart  itself.  The  first  attack  often  proves  fatal,  but 
some  people  have  several  attacks  before  they  die.  The  pain 
is  intense,  like  no  other  pain  on  earth,  and  accompanied 
by  a  fear  of  impending  death.  It  lasts  about  a  minute. 
The  cause  of  the  condition  is  almost  unknown. 

Persons  who  have  had  one  attack  must  regard  themselves 
as  likely  to  have  another,  and  they  should  always  carry 
about  with  them  small  glass  capsules  of  amyl  nitrite,  the 
vapor  of  which,  released  by  breaking  the  tube,  is  to  be 
inhaled  by  the  patient.  Recurrence  of  the  attacks  may, 
perhaps,  be  prevented  by  avoidance  of  excitement. 

Antiseptics  are  substances,  mostly  of  a  chemical  or  min- 
eral nature,  which  possess  the  property  of  arresting  or 
preventing  the  growth  of  bacterial  organisms  which  are 
capable  of  producing  poisonous  substances  in  animal  tis- 
sues with  death  or  decay  of  the  body  cells.  The  changes 
which  take  place  in  a  wound  or  ulcer  or  sore  when  germs 


12  APOPLEXY 

get  into  it  are  called  septic  processes,  sepsis,  or  putrefac- 
tion. (See  also  "Abscesses"  and  "Inflammation.") 

The  choice  of  an  antiseptic  must  depend  upon  the  pur- 
pose for  which  it  is  to  be  used. 

The  following  is  a  list  of  the  better  known  antiseptics. 

Bichloride  of  Mercury  or  Corrosive  Sublimate.  Pre- 
pared in  tablets.  Used  in  strengths  of  1  in  1000  or  in  1  in 
2000  parts  of  water,  for  inflammatory  processes  of  bacterial 
origin. 

Peroxide  of  Hydrogen.  Used  in  full  or  %  strength  to 
cleanse  dirty  and  infected  wounds. 

Boracic  Acid.  Saturated  or  yz  saturated  solution.  For 
mild  inflammations  of  mucous  membranes. 

lAsterine,  borolyptol,  eucalyptol,  borine,  alkalol  and 
glycothymoline.  For  toilet  antiseptic  purposes,  as  mouth 
washes,  etc. 

Alcohol,  and  Tincture  o/  Iodine.  Both  are  good,  in  full 
or  %  strength,  as  skin  antiseptics  when  the  skin  surface  is 
not  broken. 

Potassium  permanganate.  One  in  250  parts  of  water. 
An  active  oxidizing  agent  with  antiseptic  and  deodorizing 
properties. 

Carbolic  acid  is  little  used  nowadays  on  account  of  the 
danger  resulting  trom  strong  solutions  or  when  it  is  in- 
completely dissolved. 

Among  the  best  known  antiseptic  powders  are  iodoform, 
dermatol  and  aristol. 

Apoplexy. — This  is  the  medical  name  for  a  "stroke." 
The  person  affected  falls  down  as  if  struck,  unconscious, 
breathing  heavily  and  snoring.  Before  the  attack  there 
are  generally  some  warnings,  such  as  headache  and  sudden 
giddiness  on  stooping,  noises  in  the  ears,  temporary  deaf- 
ness or  blindness,  squinting,  nose-bleeding,  vomiting,  de- 
pression, sleepiness,  thick  speech.  Certain  persons  are 
more  liable  than  others  to  have  a  stroke.  Such  are  the 
sedentary,  the  high  livers,  with  fat  stomachs,  large  heads, 
florid  cheeks,  and  short  thick  necks,  and  persons  over  fifty. 
Intemperance  and  its  resulting  kidney  disease  make  people 
very  liable  to  apoplexy. 

A  stroke  may  have  various  results — complete  recovery 
occasionally  occurs;  some  paralysis  of  the  hand,  arm,  or 
leg  may  remain,  with  or  without  loss  of  the  faculty  of 
speech;  or  death  may  occur.  An  attack  of  apoplexy  may 


APPENDICITIS  13 

come  on  in  one  of  three  ways.  (1)  The  patient  falls  down 
unconscious,  with  red  face,  snoring,  and  convulsions;  or 
(2)  he  has  a  violent  pain  in  the  head,  is  pale,  sick  and 
faint  and  gradually  becomes  unconscious;  or  (3)  he  sud- 
denly becomes  paralyzed,  but  does  not  lose  his  senses.  He 
may  recover  or  get  worse.  Sometimes  you  see  a  man  in 
the  street  "in  a  fit,"  and  the  fit  may  be  epileptic  or  apo- 
plectic, or  perhaps  only  drunken.  It  is  sometimes  ex- 
tremely difficult  even  for  a  doctor  to  decide  whether  a  man 
is  drunk  or  ill,  and  whether  he  ought  to  be  left  to  the  police 
or  carefully  looked  after.  Such  a  man  in  a  fit  may  be 
both  drunk  and  ill,  or  might  have  become  ill  and  taken  some 
alcohol  to  cure  himself  in  vain.  These  "fits"  are  quite 
beyond  the  power  of  the  ordinary  layman  to  deal  with. 
He  ought  on  no  account  to  administer  brandy  or  any  strong 
alcoholic  drink,  unless  he  chooses  to  run  the  risk  of  being 
censured  by  a  coroner,  and  the  sick  man's  death  attributed 
by  the  doctor  to  his  interference.  All  he  can  do  is  to  give 
the  sufferer  as  much  air  as  possible,  to  loosen  belts,  bands 
and  collar,  and  prevent  his  damaging  himself  in  his  strug- 
gles, and  to  await  the  doctor's  arrival. 

Appendicitis. — As  most  people  know,  the  abdomen  con- 
tains, coiled  up  in  it,  a  very  long  tube  (about  26  feet,  in 
fact),  called  the  intestine,  or  gut,  or  bowel.  In  this  tube 
the  food  after  leaving  the  stomach  is  mixed  with  various 
digestive  juices,  such  as  the  bile,  and  when  ready,  is  ab- 
sorbed into  the  blood  vessels  of  the  gut,  and  thence  into 
the  general  circulation,  to  be  made  into  blood  fit  to  nourish 
the  body.  Now,  the  tube  which  extends  from  the  stomach 
onwards  for  20  feet,  is  a  narrow  tube,  called  the  small  gut ; 
then  begins  a  much  larger  tube  which  goes  on  to  the  back 
passage.  This  larger  tube,  the  large  intestine,  begins  at 
a  spot  just  beneath  the  skin  of  the  belly,  on  the  right  side, 
close  to  the  bony  prominence  of  the  hip.  At  a  few  inches 
from  the  beginning  of  the  large  bowel,  there  is,  in  most 
people,  a  little  blind  tube  hanging  from  it.  This  little  bit 
of  a  tube  is  only  about  as  big  as  a  goosequill,  from  two  to 
five  inches  long,  and  is  of  no  use  whatever.  It  is  called 
the  appendix,  and  sometimes  the  food  or  foreign  bodies  as 
they  pass  along  through  the  large  intestine,  set  up  irrita- 
tion and  inflammation  in  it.  For  instance,  a  cherry-stone, 
swallowed,  may  irritate  the  appendix  and  so  cause  it  to 
inflame,  and  bring  on  appendicitis  itself.  The  abscess 


14  APPETITE 

which  forms  as  the  result  of  all  this  bursts  at  last  into  the 
belly  cavity,  or  is  opened  by  the  surgeon.  But  not  all 
cases  of  appendicitis  get  as  far  as  that. 

The  causes  of  appendicitis  are  many  and  various.  While 
nobody  knows  how  to  avoid  getting  the  disease  it  is  be- 
lieved that  of  any  one  cause  constipation  is  the  most  potent. 

The  symptoms  of  appendicitis  are  these: — (1)  Sudden 
pain  all  over  the  belly,  getting  worse  and  worse,  and  finally 
settling  down  to  the  right  side  of  the  lower  part.  The  sick 
man  lies  on  his  back  and  draws  his  right  leg  up.  (2)  Loss 
of  appetite,  sickness,  constipation.  (3)  Tenderness  to 
the  touch,  especially  at  a  point  two-and-half  inches  from  the 
bony  prominence  of  the  hip-bone  in  the  direction  of  the 
navel.  (Dr.  McBurney's  "Spot.")  (4)  Feverishness. 
(5)  Swelling  in  the  part  referred  to. 

In  an  ordinary  case  these  symptoms  increase  for  a  few 
days,  then  gradually  subside  and  the  disease  gets  well. 

Treatment. — Very  light  milk  diet,  and  rest  in  bed. 
Poultices  or  an  ice-bag  to  the  painful  region.  Do  not  give 
purgative  medicines. 

All  cases  must  be  seen  by  a  doctor,  who  alone  can  tell 
whether  they  are  going  to  be  serious  or  not  and  whether 
an  operation  will  be  necessary  or  not. 

Appetite,  Good,  Bad  and  Indifferent. — By  appetite  the 
medical  man  means  the  desire  for  food  which  every  person 
possesses  when  in  good  health. 

I. — A  loss  of  appetite  is  one  of  the  earliest  signs  of  ill- 
ness, and  it  usually  continues  so  long  as  the  patient  is  in 
any  way  seriously  ill. 

It  is  so  pleasant  a  state  to  have  a  good  appetite  that 
patients  will  come  to  a  doctor  about  a  loss  of  appetite,  with- 
out being  in  any  other  way  ill.  When  this  is  the  case  the 
fact  is  generally  that  the  person  has  been  eating  too  often 
and  too  much,  or,  at  any  rate,  more  than  his  stomach  can 
manage  to  make  good  use  of.  When  too  much  food  is 
taken,  and  too  little  work  done,  the  whole  system  becomes 
overloaded  with  waste  products,  in  excess  of  the  quantity 
which  the  bowels  can  carry  off,  and  the  liver  and  kidneys 
become  affected,  and  their  whole  work  disorganized,  and 
so  the  blood  becomes  impure.  Loss  of  appetite  is  an  ad- 
vantage under  such  circumstances.  Many  people  boost  of 
a  large  appetite  who  would  live  longer  and  feel  better  if 
they  ate  less.  Rich  people,  with  good  cooks,  who  eat  heavy 


APPETITE  15 

late  dinners,  are  rarely  very  robust  for  any  long  time  to- 
gether, and  large  numbers  of  them  have  to  go  abroad  once 
a  year  to  undergo  a  course  of  abstinence  and  mineral 
waters  at  some  Spa  or  health  resort. 

Many  old  people  are  in  perpetual  suffering  from  nothing 
more  irrational  than  having  indulged  a  good  appetite  while 
they  were  young  and  reckless. 

The  old  physicians  knew  this,  and  used  to  say  that  he 
who  wants  good  health  should  care  little  about  eating,  and 
should  leave  the  table  before  he  feels  quite  satisfied. 
Among  the  poor,  however,  and  in  our  towns,  a  loss  of  ap- 
petite is  generally  a  sign  of  disease,  which  may  be  acute 
or  chronic. 

II.— All  fevers  and  states  of  inflammation  are  ushered  in 
by  want  of  appetite,  and  most  chronic  states  of  ill-health  pro- 
duce the  same  state  before  they  have  existed  for  long.  For 
example,  phthisis,  or  consumption  of  the  lungs,  scrofula, 
and  cancer.  Serious  acute  illnesses  often  leave  behind 
them  a  state  of  debility  or  weakness,  which  lasts  for  several 
weeks,  and  in  this  state  also  the  appetite  is  often  fastidious, 
and  needs  to  be  tempted. 

III. — While  loss  of  appetite  is  one  of  the  most  common 
symptoms  of  illness,  doctors  are  also  consulted  by  sick  peo- 
ple who  want  to  eat  too  much,  and  for  some  who  do  eat 
enormously. 

An  excessive  appetite  is  a  sign  of  disease  in  most  cases, 
but  we  do  also  find  it  present  in  some  persons  who  are  not 
ill  in  any  way.  Some  badly-managed  children  are  very 
large  eaters,  and  occasionally  we  see  an  adult  man  or  woman 
gorging  food ;  such  persons  are  often  weak  in  mind.  Chil- 
dren with  intestinal  worms  will  sometimes  be  found  to  have 
an  unnatural  craving  for  food.  In  olden  times  doctors 
used  to  say  that  if  a  man  had  a  tapeworm  within  him,  he 
had  to  eat  more  than  usual  to  feed  the  worm;  but  at  the 
present  day  we  should  say  that  the  tapeworm  sets  up  an 
irritation  in  the  coats  of  the  intestine,  which  shows  itself 
in  a  false  sense  of  hunger. 

Imbecile  children  will  eat  at  all  times,  and  will  eat  any- 
thing ;  even  chalk,  cinders,  coal,  and  pencils  in  some  cases. 

The  disease  called  diabetes,  not  uncommon  in  people  at 
or  beyond  middle  life,  often  gives  rise  to  a  voracious  ap- 
petite. This  disease  is  marked  by  the  production  of  an 
enormous  quantity  of  water  from  the  kidneys,  and  this 


16  ASTHMA 

urine  is  peculiar  because  it  contains  sugar  dissolved  in  it. 
Many  a  diabetic  person  will  consume  one  or  even  two 
pounds  of  rump  steak  at  a  meal  without  suffering  from 
any  indigestion.  Navvies,  coal  miners,  and  others  who 
work  long  hours  at  very  laborious  work,  and  get  high 
wages,  often  have  voracious  appetites,  and  eat  very  large 
quantities  of  food,  generally  of  a  wholesome  sort,  however ; 
but  they  eat  more  than  they  need,  for  it  is  a  mistake  to 
suppose  that  even  the  hardest  laborer  requires  all  the  food 
a  man  can  eat.  The  excess  of  food  must  be  got  rid  of  some- 
how, so  the  liver  and  kidneys  are  called  upon  to  work  in 
a  dangerous,  overloaded  condition,  and  they  frequently  get 
damaged  in  consequence  even  before  such  men  reach  the 
age  of  40,  and  in  many  cases  these  organs  break  down  com- 
pletely from  over-strain,  passing  into  states  of  disease  which 
lead  to  an  early  death.  The  over-feeding  of  children  is 
often  the  result  of  undue  encouragement  by  the  parents. 
A  child  is,  perhaps,  rather  thin,  and  is,  therefore,  prompted 
to  stuff,  and  so  gets  into  the  habit  of  over-eating.  In  many 
such  cases  we  have  observed  the  child  to  get  no  plumper, 
and  this  is  because  it  had  not  needed  more  food,  but  better 
powers  of  digestion,  and  over-feeding  led  to  further  dis- 
orders rather  than  to  improved  nutrition. 

Ascites. — Sometimes  patients  see  this  word  on  their  hos- 
pital tickets.  It  means  dropsy  of  the  belly.  The  abdomen 
is  full  of,  or  contains,  fluid,  and  may  have  to  be  tapped. 
It  may  be  caused  by  disease  of  the  liver,  heart  or  kidneys. 
(See  "Dropsy.") 

Asthma. — This  word  is  often  used  loosely  to  mean  any 
kind  of  shortness  of  breath.  It  should  only  be  used  to 
refer  to  a  spasmodic  disorder  of  the  air  passages,  neither 
acute  nor  chronic,  but  paroxysmal  (occasional).  It  is 
liable  to  complicate  chronic  bronchitis,  but  it  is  an  error 
to  believe  that  all  extra  severe  attacks  of  that  complaint 
are  connected  with  real  asthma. 

Shortness  of  the  breath  which  is  not  spasmodic  is  usually 
caused  by  some  organic  disease  of  the  lungs,  heart,  or  kid- 
neys and  is  best  cared  for  by  the  sufferers'  placing  them- 
selves, at  the  earliest  possible  moment,  in  the  hands  of  a  com- 
petent physician,  who  can  determine  the  cause  and  direct  the 
proper  treatment. 

A  patient  who  is  subject  to  asthma  seems  perfectly  well 
before  the  attack  and  then  is  suddenly  seized,  often  dur- 


ASTHMA  17 

ing  sleep,  with  the  most  violent  breathlessness ;  feeling  a 
tightness  at  the  chest,  he  gasps  for  breath  and  grasps  at 
near  objects  such  as  the  bedpost  to  help  him  to  breathe. 
The  attack  may  last  a  few  hours  or  a  few  days,  and  then 
suddenly  pass  off.  One  of  the  curious  features  of  people 
who  suffer  from  asthma  is  their  tendency  to  skin  eruptions. 

The  real  and  exact  cause  of  the  attacks  is  a  spasmodic 
narrowing  of  the  air-passages  of  the  lungs,  but  what  causes 
the  spasm  is  very  often  not  known.  A  nerve-troubled 
family  history  is  generally  found  in  people  who  have  these 
attacks,  and  sometimes  instead  of  an  attack  of  asthma  they 
will  have  one  of  gout,  or  neuralgia,  or  madness. 

No  doubt  every  lung  disease  predisposes  a  little  to  attacks 
of  asthma,  especially  in  gouty  people.  Some  climates 
cause  attacks,  while  others  seem  to  do  them  good.  But  no 
doctor  can  safely  prophesy  what  sort  of  climate  will  cer- 
tainly suit  a  given  case  of  asthma.  If  you  have  attacks 
where  there  are  trees,  go  where  there  are  none ;  if  by  the 
sea,  then  go  inland. 

It  is  pretty  certain  that  attacks  of  indigestion  cause 
attacks  of  asthma  in  those  subject  to  them.  So  all  asth- 
matics ought  to  avoid  cheese,  pickles,  celery,  sardines, 
pastry,  porter,  pork,  and  nuts.  No  late  suppers  should  be 
taken  on  any  account. 

Between  the  attacks  one  can  only  try  and  live  quietly  and 
without  much  excitement.  As  to  climate,  the  sick  per- 
son, whether  a  child  or  an  adult,  should  live,  if  possible, 
away  from  fogs,  dust,  and  smoke.  More  than  that  cannot 
be  said  about  the  climate.  Solid  food  should  not  be  taken 
after  four  o'clock  in  the  afternoon.  Children  are  often 
asthmatic  and  do  not  "grow  out"  of  the  disease. 

Iodide  of  sodium  may  be  taken  with  advantage  by  most 
asthmatic  people  twice  daily,  in  five-grain  doses. 

Before  an  attack,  the  sufferer  may  take  lobelia  or 
pyridine,  but  both  drugs  must  be  taken  only  under  medi- 
cal supervision.  Milk  is  the  only  diet  allowed  during  the 
attacks.  As  for  inhaling  the  smoke  of  asthma-powders,  it 
is  a  useful  proceeding.  White  blotting  paper,  soaked  in 
a  saturated  solution  of  nitrate  of  potash,  and  two  or  three 
strips  of  it  burnt,  and  the  vapor  inhaled,  is  a  simple 
remedy.  Many  people  find  instant  relief  by  smoking 
stramonium  or  cubeb  cigarettes. 

The  disease  itself  does  not  shorten  life.    People  do  not 


18    BABIES  LOST  BY  OVERLAYING  IN  BED 

die  in  attacks  of  asthma.  But  if  they  occur  too  frequently, 
they  increase  the  bronchitis  which  they  too  often  accom- 
pany. Once  in  a  while,  a  child  grows  out  of  the  complaint, 
but  adults  never  lose  it  altogether. 

Babies  Lost  by  Overlaying  in  Bed. — Is  it  not  a  very  serious 
state  of  affairs  that  hundreds  of  babies  are  overlain  in 
London  and  New  York  every  year?  And  can  nothing  be 
done  to  make  infant  life  more  safe  ?  The  root  of  the  matter 
lies  in  the  old  custom  of  the  country — that  of  having  an 
infant  to  sleep  in  the  mother's  arms,  or  at  any  rate,  in  her 
own  bed,  and  with  the  father.  Overlaying  is  practically 
unknown  on  the  Continent  of  Europe,  the  reason  being  that 
it  is  a  recognized  custom  for  parents  to  obtain  a  cot  as  soon 
as  a  baby  comes.  The  old-fashioned  wooden  box,  cot,  or 
cradle  used  to  be  handed  down  from  one  generation  to 
another,  and  used  for  every  baby  as  it  came  along.  In 
Germany  and  some  other  countries,  there  was  a  strict  law 
that  no  mother  or  nurse  should  have  an  infant  under  two 
years  of  age  in  bed  with  her,  under  a  heavy  penalty,  and, 
if  the  law  being  broken  resulted  in  a  child's  death,  and 
an  infant  got  suffocated  in  bed  with  a  grown-up  person, 
there  was  a  conviction  for  manslaughter,  and  a  long  im- 
prisonment followed. 

In  this  country  there  are,  of  course,  many  cradles  in 
use,  especially  in  country  districts,  but  in  our  cities  and 
among  the  poor  it  is  an  almost  invariable  rule  to  find 
young  infants  in  bed  with  both  parents.  We  want  to 
teach  parents  that  the  life  of  an  infant  under  one  year  of 
age  is  never  safe  in  bed  with  a  mother;  it  is  too  feeble  to 
breathe  easily  under  any  covering,  and  suffocation  is  bound 
to  follow  when  an  infant's  mouth  and  nose  get  squeezed 
against  a  mother's  breast,  or  if  her  arm  rest  upon  or  over 
them,  or  even  if  heavy  bedclothes  get  pulled  up  over  a 
child's  head.  Until  baby  is  a  year  or  more  old  it  is  sel- 
dom strong  enough  to  rouse  up  a  mother  when  it  is  dying ; 
its  struggles  for  fresh  air  are  too  feeble  to  awake  a  woman 
who  sleeps  soundly.  In  our  towns  women  work  hard  and 
go  to  bed  late;  sleep  like  logs,  many  of  them,  for  hours, 
in  utter  ignorance  that  the  baby  whom  they  love  is  dying 
beneath  them.  There  is  no  medicine  which  can  make 
mothers  sleep  lightly,  and  there  are  no  means  of  avoiding 
overlain  babies  except  by  insisting  on  the  use  of  a  cradle. 
It  is  only  reasonable  to  urge  that  the  clergy  should  do  their 


BALDNESS  19 

best  to  get  this  reform  carried  out.  There  are,  of  course, 
numbers  of  babies  overlaid  because  their  mothers  drink 
too  much,  but  we  feel  quite  sure  that  the  number  of  such 
is  small  compared  with  the  total  number  of  babies  who  die 
suffocated  in  bed,  overlaid  by  parents  tired  with  the  day's 
work. 

There  is  no  reason  for  the  non-possession  of  a  cot  for  the 
baby. 

Backache. — Pain  in  the  back  is  a  very  common  ailment 
indeed,  especially  that  form  of  it  called  by  women  "  bear- 
ing-down pain."  It  is  very  often  a  sign  of  nothing  more 
than  tiredness  of  the  muscles  of  the  back ;  but,  on  the  other 
hand,  it  may  be  a  symptom  of  disease  in  some  internal 
organ. 

Under  "LUMBAGO"  you  will  find  a  full  account  of  the 
pain  due  to  rheumatic  trouble  in  the  back  muscles,  as  well  as 
several  valuable  ways  of  dealing  with  all  kinds  of  back- 
aching.  Backache  in  young  growing  persons  may  be  due 
to  general  debility,  and  then  keep  an  eye  open  for  curva- 
tures and  weakness  of  the  spine.  Actual  disease  of  the 
spine  itself  more  often  causes  what  is  called  "referred" 
pain  in  the  front  of  the  belly.  Some  kinds  of  kidney  di- 
seases (see  "Kidney  Diseases")  cause  backache.  Gall- 
stones cause  backache  especially  on  the  right  side  and  in 
the  right  shoulder.  Ulcer  of  the  stomach  (see  "Stomach 
Diseases")  will  often  cause  local  pain  in  the  back  at  the 
level  of  the  last  rib.  But  the  commonest  causes  of  women 's 
backache  are  menstrual  disorders,  catarrhs  of  the  womb, 
falling  of  the  womb  (due  to  getting  up  too  soon  after  mis- 
carriage or  childbirth),  inflammation  of  the  womb,  and 
tumors  of  every  kind,  connected  with  womb  or  ovaries. 

Very  little  can  be  done  towards  curing  the  backache  un- 
til we  know  what  causes  it.  If  a  young  man  or  woman 
has  severe  backache,  that  is  not  due  to  "growing  pains," 
or  general  weakness,  or  curvature  of  the  spine,  let  him  or 
her  save  a  sample  of  the  urine  which  he  or  she  passes  first 
in  the  morning,  and  submit  it  to  the  doctor  for  analysis. 
Under  "LUMBAGO"  will  be  found  plenty  of  "cures"  for 
those  whose  backache  is  due  to  something  that  cannot  be  dis- 
covered, or  cannot  be  treated,  and  we  refer  all  sufferers 
to  that  article. 

Baldness. — This  may  be  permanent,  as  in  old  age,  or 
temporary  as  after  fevers,  in  debility,  syphilis,  and  con- 


20  BANTING 

sumption.  Even  those  who  are  bald  with  increasing  age 
need  not  despair,  however,  for  so  long  as  any  hair-growing 
follicles  are  left  in  the  skin  they  may  be  stimulated  into 
activity.  The  hair  requires  plenty  of  brushing  and  wash- 
ing about  once  a  fortnight,  or  three  weeks.  The  washing 
should  be  done  in  hot  water,  with  a  little  household  am- 
monia in  it,  and  then  some  ordinary  yellow  soap  should  be 
used,  or,  better  still,  egg  julep  as  a  lather.  When  the 
scalp  is  clean,  dry  it  and  the  hair  by  rubbing  with  rough 
towel. 

A  good  hair-wash  for  the  baldness  following  an  illness 
is — Castor  oil,  20  parts;  tincture  cinchona,  10  parts;  tinc- 
ture rosemary,  10  parts;  tincture  jaborandi,  10  parts;  bay 
rum,  100  parts.  Shake  well  and  rub  into  scalp  frequently. 

Women  who  are  weak  and  anaemic  should  try  this  lotion 
to  prevent  hair  shedding: — Salicylic  acid,  3  drachms; 
liquefied  carbolic  acid,  1  drachm;  castor  oil,  3  drachms; 
alcohol,  q.  s.  to  6  ounces.  Make  a  lotion.  To  be  rubbed  into 
scalp. 

When  the  hair  falls  off  because  of  scurfmess  of  the  scalp, 
use  this  lotion: — Resorcin,  1  drachm;  ether  and  castor  oil, 
of  each,  1  drachm;  eau  de  cologne,  one  ounce;  rectified 
spirits,  6  ounces.  Mix. 

If  the  scurf  is  very  thick  and  very  greasy,  and  the  hair 
comes  out  by  the  roots,  try  this  lotion : — Resorcin,  40  grains, 
ether  and  castor  oil,  2  drachms;  eau  de  cologne,  half-an- 
ounce ;  bay  rum,  four  ounces.  Rub  into  the  roots  night  and 
morning  on  clean  rag,  which  is  to  be  burnt  immediately 
after  use.  (See  also  "Skin  Diseases"  IV.) 

Banting. — "Doing  Banting"  means  dieting  one's  self  in 
a  special  way  in  order  to  get  thin.  Banting  was  the  in- 
ventor of  this  particular  method  of  reducing  weight.  In 
one  year,  Banting  reduced  his  weight  from  196  to  154 
pounds. 

The  Banting  diet  is  very  scanty,  but  many  very  fat 
people  adopt  it  with  good  results.  Here  is  the  dietary: — 

Breakfast. — Six  ounces  of  meat,  any  meat  except  pork 
or  veal;  one  ounce  of  dry  toast,  or  dry  biscuit;  10  ounces 
(half-a-pint)  of  coffee  or  tea,  without  sugar.  Dinner  (five 
hours  later). — Six  ounces  of  meat  (except  pork,  veal,  eels, 
salmon  or  herring),  or  of  any  kind  of  poultry  or  game; 
six  or  eight  ounces  of  any  vegetable  except  potato,  beetroot, 
turnip,  carrot  or  parsnip ;  one  ounce  of  dry  toast ;  a  plate 


BARRENNESS  21 

of  cooked  fruit,  unsweetened ;  10  ounces  of  claret  and  water. 
Tea  (four  hours  later). — Three  ounces  of  cooked  fruit,  un- 
sweetened, with  plain  rusks;  eight  ounces  of  tea  without 
milk  or  sugar.  Supper  (three  hours  later). — Four  ounces 
of  meat  or  fish,  or  game,  or  poultry,  as  at  dinner;  six 
ounces  of  claret,  or  claret  and  water. 

This  method  of  treating  extreme  fatness  is  deservedly 
popular,  but  for  some  people  it  may  not  be  enough  to  keep 
up  the  strength.  Such  people  should  not  try  and  eat 
more,  but  should  adopt  the  Oertel  method,  which  is  similar, 
but  has  a  higher  proportion  of  fat  and  starchy  foods,  and 
is  combined  with  regulated  hill-climbing. 

Barbers'  Itch. — Hairdressers  generally  know  enough 
about  skin  diseases  to  be  aware  that  they  sometimes  help 
to  spread  contagious  skin  diseases  by  insufficient  attention 
to  the  cleanliness  of  brushes  and  other  utensils  which  they 
make  use  of  in  the  ordinary  course  of  business.  One  of 
these  is  called  "barbers'  itch."  It  may  affect  the  eye- 
brows, eyelashes,  mustache,  beard,  and  armpits  and 
groins.  There  are  little  tender  pimples  which  form  around 
the  hairs,  and  develop  into  tiny  abscesses  (pustules),  and 
the  hairs  come  out  easily.  When  the  hairs  are  out  the 
matter  comes  out  too,  and  perhaps  at  once  affects  the  next 
hair-sheath.  The  disease  is  most  obstinate  to  cure.  The 
hairs  have  to  be  pulled  out  and  the  matter  has  to  be  gently 
squeezed  out  of  the  follicles;  after  that  you  must  rub  in 
some  antiseptic  ointment,  such  as  yellow  oxide  of  mercury 
ointment,  or  2  per  cent,  resorcin  in  vaseline  or  cacao  butter. 

Under  the  heading  of  ' '  Hairdressers ' '  we  give  some  hints 
as  to  the  prevention  of  such  diseases. 

Barley  Water  for  Invalids. — DIRECTIONS. — Mix  one 
dessert-spoonful  of  Robinson's  Patent  or  Prepared  Barley 
with  a  wineglassful  of  cold  water  into  a  smooth  paste. 
Pour  this  into  a  stewpan  containing  one  quart  of  boiling 
water,  and  stir  over  the  fire  for  five  minutes.  Flavor  with 
lemon  and  sugar,  either  or  both,  according  to  taste,  allow 
the  mixture  to  cool,  and  strain  off  the  barley  sediment. 
For  invalids  requiring  nutriment,  a  large  quantity  of 
barley  should  be  used  and  the  straining  of  sediment  omitted, 
or  not,  as  directed  by  the  doctor. 

Barrenness. — The  treatment  of  barrenness  must  obviously 
depend  on  the  cause  of  it,  and  only  a  doctor  can  decide 
this  point. 


22  BATHING 

Bathing,  The  Importance  of. — In  order  to  maintain  good 
health,  it  is  of  the  utmost  importance  to  keep  the  skin  of 
the  whole  body  clean.  "We  may  notice  among  persons  whose 
habits  we  know  of,  that  those  who  take  daily  baths  are  not- 
able for  health  and  for  having  a  good  color  and  clear  com- 
plexion. We  are  constantly  getting  rid  of  used-up  mate- 
rial through  our  skins  by  perspiration  and  by  evaporation. 
The  pores  of  the  skin  tend  to  become  blocked  up  unless 
often  washed,  and  when  the  pores  are  obstructed  more  work 
is  thrown  on  the  kidneys.  Persons  in  robust  health  are  all 
the  better  for  having  a  daily  bath  of  cold  water ;  those  who 
are  less  strong  are  wise  to  have  a  morning  bath  of  warmed 
water.  Such  a  practice  is  well  worth  the  trouble  of  the 
process  and  the  loss  of  time,  and  it  should  be  followed  in 
houses  with  conveniences  for  it.  When  a  daily  bath  is 
not  practicable,  a  warm  bath  should  be  taken  once  a  week 
at  bedtime,  and  during  pleasant  weather  a  bath  in  the 
sea,  or  in  a  river,  or  in  a  town  swimming-bath,  is  very 
desirable.  It  is  not  desirable  to  remain  in  any  bath  very 
long,  and  on  getting  out  the  whole  body  should  be  rubbed 
with  rough  towels  until  the  skin  is  all  pink  and  glowing 
with  warmth.  When  a  person  does  not  feel  a  hot  glow  after 
a  cold  bath,  he  should  not  bathe  in  quite  cold  water.  It 
is  only  foolhardiness  to  risk  taking  cold  baths  in  the  open 
air  during  winter  weather.  Medical  men  describe  and  ad- 
vise several  sorts  of  baths.  For  instance,  the  cold  bath 
generally  means  the  use  of  water  just  at  the  temperature 
it  happens  to  be  according  to  the  weather.  Baths  of 
warmed  water  require  the  use  of  a  thermometer  to  regulate 
the  heat  to  the  degree  ordered.  In  general  domestic  use, 
of  course,  it  is  customary  to  test  the  heat  of  the  water  by 
the  hand;  this,  however,  is  an  uncertain  guide.  Delicate 
children  may  easily  be  scalded  by  hot  water  which  does  not 
feel  painful  to  a  nurse's  hand.  A  bath  called  by  a  doc- 
tor "tepid"  means  of  heat  between  84  and  92  degrees 
Fahrenheit  scale.  A  warm  bath  is  from  92  to  98  degrees; 
the  latter  is  blood-heat.  This  feels  hot  to  the  whole  body, 
and  is  most  suitable  for  a  general  washing  with  soap.  A 
hot  bath  is  of  a  heat  from  98  to  105 ;  this  is  only  to  be  used 
as  a  form  of  medical  treatment.  A  mustard  foot-bath  is 
made  with  a  half-teacupful  of  mustard  powder  to  a  gallon 
of  hot  water.  An  alkaline  bath,  used  in  skin  disease,  is 
made  by  adding  carbonate  of  soda  to  warm  water.  A 


BEDSORE  23 

sulphur  bath,  to  cure  itch,  is  made  by  adding  two  drachms 
of  sulphurated  potash  to  each  gallon  of  water.  Soak  the 
affected  hands  and  arms  in  it. 

Bed  Case. — This  is  an  old-fashioned  name  for  cases  of 
hysteria  of  a  certain  kind.  Instead  of  being  up  and  about, 
doing  their  share  of  work  in  the  world,  the  subjects  of  this 
pitiable  condition  prefer  to  be  regarded  as  interesting  in- 
valids. They  dislike  being  told  that  they  look  well.  They 
like  to  believe,  or  to  make  their  friends  believe,  that  they 
have  a  mysterious  internal  complaint,  and  that  their  doctor 
considers  them  very  interesting  and  obscure  cases.  They 
often  are  tranquil  and  cheerful,  and  have  good  digestions 
for  dainty  food.  They  always  have  some  speciality  in  the 
way  of  a  disease — always  obscure  and  invisible.  Either  it 
is  * '  something  wrong  with  the  spine, ' '  or  with  the  * '  womb, ' ' 
or  ' '  the  nerves, ' '  and  they  say,  in  order  to  attract  the  sym- 
pathy which  is  as  bread  and  cheese  to  their  vain  and  little- 
minded  selves,  that  they  have  ''horrible  pains/'  If  these 
patients  can  be  brought  into  a  healthier  state  of  mind  by 
cheerful  companions,  or  nurses  who  will  stand  no  non- 
sense, they  may  be  cured.  But,  unfortunately,  too  many 
of  them  are  quite  comfortable  in  their  selfishness  and  do 
not  in  the  least  desire  to  be  made  like  other  people,  or 
deprived  of  their  friends '  sympathy.  (See  l ' Neurasthenia" 
and  "Hysteria.") 

Bedsore. — A  bedsore  is  a  sore  or  ulcer  which  forms  on 
some  part  of  a  bed-ridden  invalid,  and  it  is  due  to  pressure 
and  moisture  combined.  The  chief  places  are  the  heel, 
the  buttocks  and  the  bottom  of  the  spine.  A  nurse  should 
regard  the  formation  of  such  a  sore  on  her  patient  as  a 
disgrace,  generally,  and  due  to  her  own  carelessness  or 
want  of  watchfulness.  The  sick  person  must  be  kept  quite 
dry  and  unsoiled  by  sweat,  discharges  or  urine.  Look  out 
for  redness  over  parts  which  are  lain  upon,  and  rub  them 
a  little  daily  with  methylated  spirits,  dry  thoroughly  and 
dust  with  some  clean  powder.  If  the  skin  once  gives  way, 
the  ulcer  is  very  difficult  to  heal,  and  the  doctor's  atten- 
tion must  be  called  to  it.  Otherwise  the  sick  person  will 
have  an  additional  trouble  which  ought  to  have  been 
avoided.  Bedsores  occasionally  occur  in  very  old,  para- 
lyzed, and  dying  folks,  but  in  most  cases  can  be  avoided 
by  proper  attention. 

Beef  Tea,  How  to  Make. —  (1)  Cut  up  a  pound  of  lean 


24  BEVERAGES 

gravy  beef  into  small  pieces,  put  them  into  a  covered  jar 
with  two  pints  of  cold  water  and  a  pinch  of  salt;  put  the 
jar  on  the  hob,  let  it  warm  and  simmer  gradually  for  two 
hours,  taking  care  it  never  reaches  boiling  point.  An- 
other method  is: — (2)  Chop  fine  a  pound  of  lean  beef,  add 
a  pint  of  cold  water  and  leave  for  two  hours.  Then  let 
it  simmer  on  stove  for  three  hours,  but  never  let  it  get 
much  hotter  than  160°  F.  A  thermometer  will  be  wanted 
in  nurseries  where  this  method  is  made  use  of.  Make 
up  for  the  water  lost  by  evaporation  by  adding  cold  water, 
so  that  a  pint  of  beef  tea  shall  represent  a  pound  of  beef. 
Strain,  and  carefully  squeeze  all  fluid  from  the  beef. — 
(Bartholow.)  (3)  Beef  tea  and  oatmeal — a  very  nourish- 
ing meal: — Mix  thoroughly  a  tablespoonful  of  groats  with 
two  tablespoonfuls  of  cold  water  and  add  to  a  pint  of  hot 
beef  tea  made  as  in  (1).  Heat  up  again  for  ten  minutes, 
stirring  all  the  time,  and  strain  through  a  coarse  sieve. 

Beverages. — All  "drinks"  contain  a  large  proportion  of 
water,  and,  in  fact,  the  daily  drinking  of  a  large  amount 
of  water  is  a  necessity  for  health.  An  average  adult  needs 
water,  in  one  form  or  another,  to  the  extent  of  from  2% 
to  4  pints  a  day.  It  should  be  filtered  or  boiled,  or  both. 
We  shall  now  consider  the  principal  beverages  from  a 
medical  point  of  view: — 

Tea  and  Coffee  are  much  alike  both  in  their  composition 
and  in  their  effects.  They  stimulate  the  system  and  are 
quite  harmless,  in  moderation.  Cocoa,  on  the  other  hand, 
is  a  true  food. 

Tea  ought  to  be  made  with  boiling  water,  and  water  as 
"soft"  as  possible.  If  your  tap-water  is  hard,  boil  it  for 
fifteen  minutes  with  a  pinch  of  carbonate  of  soda  before 
you  make  the  tea.  Everybody  knows  the  effects  of  tea- 
drinking.  We  need  only  say  that  green  tea  has  much 
stronger  effects  than  black.  If  tea  gives  rise  to  any  sort 
of  indigestion  or  palpitation  of  the  heart,  it  may  be  be- 
cause it  has  "stood  too  long."  In  any  case,  tea  ought  to 
be  drunk  after  a  meal,  and  not  with  a  meal,  and  a  little 
carbonate  of  soda  should  be  added  to  the  pot.  "High  tea" 
—the  meal  consisting  of  tea  and  meat — is  a  fruitful  cause 
of  indigestion. 

Coffee  ought  to  be  freshly  roasted,  and  freshly  ground 
in  order  to  be  at  its  best  as  a  drink.  Coffee  in  moderation 
stimulates  the  heart  and  lessens  the  sense  of  fatigue.  Too 


BIRTHMARKS  25 

much  coffee  may  depress  the  heart  and  make  it  irregular, 
and  cause  an  uncomfortable  feeling  in  the  cardiac  region; 
it  may  also  cause  heartburn  and  flushing  of  the  face,  es- 
pecially when  strong  black  coffee  is  drunk  after  a  meal. 
It  then  delays  digestion  of  the  food.  Strong  coffee  is  a 
splendid  antidote  to  poisoning  by  alcohol  or  opium.  (See 
"Poisoning.") 

Cocoa  is  a  very  nutritious  food.  It  contains  both  body- 
building and  energy-giving  foods,  and  should  be  used  in- 
stead of  tea  by  the  poor  especially. 

Chocolate  is  a  very  excellent  and  agreeable  drink,  con- 
taining a  deal  of  fat  and  starchy  material,  and  plenty  of 
sugar.  Bilious  people  should  not  drink  it.  It  is  a  food 
rather  than  a  beverage. 

Alcohol  is  a  useful  food  in  very  small  quantities,  an 
agreeable  stimulant  in  larger  quantities,  and  in  excess  is 
a  powerful  narcotic  poison.  A  great  authority  says  that 
one  fluid  ounce  or  one-and-a-half  ounces  of  absolute  alcohol 
in  twenty-four  hours  is  the  most  that  any  healthy  adult 
can  take  with  probable  impunity.  One  ounce  of  pure 
alcohol  is  contained  in  about: — 

2%  fluid  ozs.  of  whisky.     Half-a-pint  of  claret. 
2  fluid  ozs.  of  brandy.         Two  pints  of  bitter  beer. 
2  fluid  ozs.  of  gin.  One-and-a-half  pints  of  porter. 

1%  fluid  ozs.  of  rum.  Two-and-a-half  pints  of  lager 

beer. 
6  fluid  ozs.  of  sherry.          Two  pints  of  cider  (varies  very 

much) . 

NOTE — See  also  "Drachms"  and  "Ounces".) 
Birthmarks. — Blemishes  at  birth  are  of  various  kinds. 
The  commonest,  perhaps,  are  "port- wine  stains"  on  the 
skin.  These  are  purplish  patches  of  fantastic  shape,  due 
to  dilated  blood  vessels.  Sometimes  they  increase  in  size 
as  time  goes  on;  more  often  they  only  increase  slowly  for 
a  few  months  and  then  remain  quite  stationary.  They  can 
sometimes  be  improved  by  electrolysis,  but  more  often  not. 
Old  wives  tell  tales  about  "strawberry-marks,"  and 
"mouse-marks,"  and  say  that  they  are  the  results  of  some 
of  the  mother's  experiences  during  pregnancy;  these  no- 
tions are  but  silly  superstitions.  Other  "  mother 's-marks  " 
are  hairy  moles  and  colored  moles,  all  called  by  doctors 


26  BITES  OF  DOGS 

ncevi  (ncevus  is  the  Latin  for  mole).  These  are  more 
likely  to  be  removable  by  electrolysis. 

Bites  and  Stings  of  insects  may  be  bathed  with  tincture 
of  arnica,  onion  juice,  thymol  ointment,  or  dabbed  with  a 
piece  of  rag  or  cotton-wool  soaked  in  ammonia  solution. 
Cloudy  household  ammonia  will  do  nicely.  An  insect  bite 
must  not  be  scratched  or  a  sore  may  result  from  poisoning 
by  dirty  nails. 

Bites  of  Dogs. — If  an  ordinary  healthy  dog  bite  a  per- 
son, there  is  no  need  to  fear  hydrophobia.  Not  all  dogs 
which  bite  are  ''mad  dogs."  In  fact,  "madness"  in  dogs 
means  the  rare  disease  called  rabies.  There  is  a  very  cur- 
ious, but  entirely  nonsensical,  superstition  that  if  a  mad 
dog  which  has  bitten  someone  is  shot  afterwards  the  suf- 
ferer will  be  saved.  Rabies  in  the  later  stages  is  easy 
to  recognize;  the  poor  animal  who  suffers  from  it  lies  ill, 
curled  up  in  a  corner,  with  foamy  mouth  and  hanging 
tongue,  and  is  more  or  less  paralyzed.  In  the  earlier 
stages  of  this  "madness,"  the  dog  is  sulky,  suspicious,  and 
snappish,  and  may,  perhaps,  run  after  anyone  who  annoys 
it,  and  bite  him.  But  even  when  bitten  by  a  "mad  dog" 
a  person  need  not  develop  hydrophobia.  The  poison  in 
the  dog's  saliva  will  probably  have  been  wiped  off  in  the 
clothes  through  which  it  bites. 

For  the  same  reason  mad-dog  bites  of  the  hands  are 
dangerous  and  those  of  the  face  especially  so  on  account 
of  the  great  blood  supply. 

As  hydrophobia,  once  developed,  is  almost  always  fatal, 
the  first  thing  to  do  is  to  cauterize  the  bite.  Only  a  sur- 
geon can  do  it  properly,  but  anyone  with  the  necessary 
hardy  courage  could  burn  out  the  wound  with  a  cautery, 
such  as  is  used  for  fancy  poker-work,  or  a  red  hot  poker, 
or  a  pair  of  lady's  curling-irons. 

The  disease  is  comparatively  rare.  Still,  every  bite  of 
a  dog  ought  to  be  seen  to  by  a  medical  man. 

Hydrophobia  may  develop  a  few  days  after  the  bite, 
but  in  many  cases  there  is  an  interval  of  weeks  or  months. 

When  bitten  by  a  dog  it  is  most  important  to  establish 
the  fact  whether  the  animal  is  rabid  or  not.  This  may 
be  done  by  one  of  two  methods.  1st — Keep  the  dog  alive, 
under  observation.  2nd — Kill  the  dog,  cut  its  head  off  and 
forward,  as  quickly  as  possible,  packed  in  ice  to  some 
health  department  laboratory  where  a  diagnosis  can  im- 


BLACKHEADS  27 

mediately  be  made  by  a  microscopical  examination  of  the 
brain.  By  no  means  let  the  dog  escape,  or  be  killed  and 
lost  sight  of. 

If,  in  either  case,  the  dog  is  proved  to  have  rabies,  the 
subject  bitten  must  begin  immediately  the  Pasteur  treat- 
ment:— either  at  a  department  of  health,  a  Pasteur  In- 
stitute, or  as  can  now  be  done,  by  his  own  physician  at 
his  own  home. 

All  public  spirited  citizens  should  appreciate  the  fact 
that  rabies,  which  is  becoming  very  common  in  this  coun- 
try, can  never  be  blotted  out  until  widespread  muzzling 
of  dogs  is  carried  out — at  least  for  a  limited  period  fol- 
lowed by  a  permanent  national  quarantine — such  as  en- 
forced in  England,  where  rabies  is  now  an  unknown  disease. 

Black-Eye. — A  purple  discoloration  of  the  skin  of  the 
eyelids,  cheek,  and  perhaps  forehead,  due  to  a  blow,  or 
fall;  the  color  results  from  blood  being  effused  under 
the  skin  from  veins  bruised  by  the  violence.  Very  severe 
blows  may  have  injured  the  bone  deeper  still.  The  whites 
of  the  eyes  may  also  be  stained  crimson  or  purple.  A 
black-eye  will  gradually  get  well  if  left  alone,  but  it  is 
a  good  plan  to  apply  cold  lotions  of  spirit  and  water,  or 
vinegar  and  water,  or  a  piece  of  raw  steak,  if  attended 
to  at  once;  if  the  case  be  found  painful  at  a  later  stage 
apply  warm  poultices,  or  fomentations  of  poppyheads. 
The  dark  color  will  fade  away,  becoming  red  and  then 
yellow  before  the  skin  becomes  white  again.  In  the  final 
stage  rub  the  part  gently  with  white  vaseline,  lanolin 
or  cold  cream.  If  the  skin  is  broken  as  well  as  bruised, 
treat  the  case  with  fomentations  of  boric  lotion,  followed 
by  zinc  ointment. 

Blackheads. — There  are  comparatively  few  young  peo- 
ple whose  skins  are  entirely  free  from  "blackheads." 
They  show  as  little  black  pimples  on  the  skin  of  the  nose 
or  forehead  or  chin;  but  also  on  the  shoulders,  back,  and 
chest.  They  look  a  little  like  grains  of  gunpowder  em- 
bedded in  the  skin.  If  they  are  squeezed  out  between  the 
finger  nails,  or  with  the  barrel  of  a  small  key,  they  look 
like  little  white  curly  maggots  with  black  heads.  Some- 
times the  little  plugs  are  more  like  tiny  orange  pips.  They 
are  quite  harmless,  but  they  disfigure  the  face  very  much, 
and  they  may,  and  often  do,  become  acne  spots  (see 
"Acne").  They  ought  to  be  squeezed  out,  but  gently, 


28      BLEEDING  FROM  VARICOSE  VEINS 

because  if  it  is  roughly  done,  there  is  sure  to  be  an  acne 
spot  formed  there,  and  then  the  skin  must  be  washed 
vigorously  with  soft  soap  and  hot  water  and  dried  with 
a  rough  towel.  This  ought  to  be  done  at  bedtime,  and 
then  the  following  paste  must  be  rubbed  in : — Glycerine,  six 
drachms;  kaolin,  one  ounce;  and  vinegar,  half-an-ounce. 

Bladder,  Diseases  of. — There  are  two  ''bladders"  in  the 
human  body — the  gall  bladder  in  the  liver,  and  the  urinary 
bladder,  to  which  the  urine  passes  as  it  comes  from  the 
kidneys  until  the  bladder  gets  uncomfortably  full.  In- 
flammation of  the  urinary  bladder  is  called  cystitis. 

1. — The  signs  of  cystitis  are: — Pain  in  center  of  lowest 
part  of  the  belly;  too  great  frequency  in  passing  water; 
bad  smell,  turbidity,  and  whitish  sediment  in  the  urine; 
f everishness ;  shivering  fits. 

Treatment  of  acute  cystitis. — Rest  in  bed,  hot  hip  baths, 
milk  diet,  plenty  of  water  to  drink,  and  urotropin  (5 
grains)  to  be  taken  three  times  a  day.  This  is  the  treat- 
ment of  an  attack  of  cystitis  caused  by  catching  cold. 
But  cystitis,  and  pain  and  bloody  urine,  may  be  due  to 
a  stone  in  the  bladder,  or  to  other  things,  and  then  the 
disease  requires  very  skilled  treatment.  Other  diseases 
of  the  bladder  are  irritability,  tumors,  and  rupture  (noth- 
ing to  do  with  " hernia"). 

II. — Irritability  of  the  bladder  (with  very  frequent  de- 
sire to  pass  water)  may  be  caused  by  cystitis,  stone, 
stricture,  enlarged  prostate  gland,  gouty  acidity  of  the 
urine,  piles,  too  tight  foreskin,  etc.  The  treatment,  of 
course,  depends  on  the  cause,  which  only  a  doctor  can 
decide. 

Bleeding  from  Varicose  Veins. — In  persons  who  suffer 
from  varicose  veins  the  skin  of  the  parts  affected  at  length 
becomes  brownish,  shiny,  and  so  badly  nourished  that  the 
very  slightest  injury  may  give  rise  to  a  troublesome  sore. 
The  sore  does  not  heal  because  the  parts  are  so  badly  sup- 
plied with  blood,  and  the  ulcer  (see  under  "Ulcers" — 6) 
may  penetrate  to  one  of  the  swollen  veins  under  it  and  give 
rise  to  a  sudden  copious  loss  of  blood.  In  a  few  seconds 
the  sufferer  may  lose  blood  enough  to  cause  a  serious  faint- 
ing fit,  which  arrests  the  bleeding  for  a  short  time.  If 
you  ever  see  anyone  bleeding  furiously  from  a  sore  on 
the  leg  where  there  are  knotted  and  swollen  veins,  make 
him  lie  down  on  his  back,  raise  the  leg,  and  apply  pressure 


BLISTERS  29 

with  a  handkerchief  rolled  into  a  pad,  directly  on  to  the 
Heeding  spot  and  bandage  it  tightly  there,  or  bandage  both 
above  and  below  the  wound.  Then  send  for  a  doctor. 

BLEEDING  from  the  back  passage,  or  rectum,  generally 
shows  the  presence  of  piles,  or  ulceration,  or  inflammation 
of  the  bowels.  A  small  occasional  loss  of  blood  in  a  full- 
blooded  person  is  rather  a  good  thing,  but  in  all  cases 
a  doctor  should  be  told  about  it,  as  it  may  be  curable,  or 
it  may  be  the  sign  of  a  disease  elsewhere  which  ought  to 
be  medically  treated. 

BLEEDING  from  the  nose.     (See  "Nose-bleeding.") 

BLEEDING  WOUNDS. — When  a  cut  is  received  on  fingers  or 
arms  the  wound  should  first  be  thoroughly  cleaned  with 
water  and  peroxide  of  hydrogen  or  bichloride  of  mercury 
solution  (1-1000).  Then  pressure  should  be  applied — pref- 
erably with  sterile  gauze  and  a  firm  bandage  applied.  If 
the  cut  has  been  a  severe  one  this  may  have  to  be  followed 
by  attention  from  a  physician  to  tie  off  the  bleeding 
points  and  perhaps  sew  up  the  wound.  All  wounds  of 
the  face,  when  small  ones,  should  be  sewed  up  by  a  physi- 
cian, otherwise  the  numerous  muscles  of  that  part  of  the 
body  will  cause  the  wound  to  gape  and  leave  an  ugly 
scar. 

If  the  bleeding  from  a  wound  can  not  be  controlled  by 
direct  pressure  a  tourniquet  should  be  applied  with  pres- 
sure over  the  main  artery  of  the  extremity  some  place  on 
the  heart  side  of  the  wound. 

Blisters. — A  blister  is  a  watery  bleb  of  the  skin.  It  may 
be  caused  on  the  hands  by  rowing,  or  other  exercise,  and 
on  the  feet  by  too  much  walking.  A  burn  may  cause  a 
blister,  so  may  a  bruise,  or  a  scald,  or  an  attack  of  ery- 
sipelas. 

For  feet  inclined  to  blister,  bathe  daily  with  a  lotion 
of  alum  and  10  per  cent,  chromic  acid  (poison),  or  smear 
the  inside  of  the  socks  with  dry  soap.  For  actual  blisters, 
prick  them  with  a  clean  needle,  let  the  fluid  out,  and  put  on 
a  piece  of  soap-plaster  or  other  clean  dressing.  For  small 
blisters,  leave  them  alone ;  if  inflamed,  apply  zinc  ointment 
or  show  them  to  the  doctor.  If  the  blister  has  not  been 
caused  by  any  ordinary  event,  it  may  be  a  symptom  of 
a  skin  disease,  and  skilled  advice  must  be  obtained. 

Blistering  may  be  produced  artificially  by  certain  plasters, 
or  by  blistering  fluid,  for  the  purpose  of  curing  pain  or 


30  BOILS 

bringing  down  inflammation.  A  blister  should  never  be 
put  on  without  medical  advice. 

Blood-Spitting. — This  means  coughing  up  blood,  and  blood 
can  only  be  ' '  coughed ' '  up  from  the  windpipe  or  the  lungs. 
Sometimes  an  aneurism  (see  "Aneurism")  bursts  into  the 
air  passages,  but  in  all  other  cases  blood  from  the  lungs 
means  lung  disease  more  or  less  serious.  The  coughing  up 
of  blood  is  accompanied  by  a  tickling  sensation  in  the 
throat,  and  the  patient  goes  on  coughing  up  blood  for 
some  little  time;  the  blood  is  generally  scarlet,  and  mixed 
with  air-bubbles.  The  commonest  cause  of  blood-spitting 
is  tuberculous  disease  of  the  lung;  then  comes  congestion 
of  the  lung  from  chronic  heart  disease;  then  acute  pneu- 
monia and  bronchitis ;  then  disease  of  the  voice  box ;  then 
an  aneurism;  and  the  most  unusual  cause  is  from  con- 
stitutional disorders,  such  as  scurvy. 

When  a  patient  begins  to  spit  blood  in  small  quantity 
put  him  to  bed  and  give  him  pieces  of  ice  to  suck,  or  sips 
of  cold  water.  If  he  spits  or  coughs  up  a  large  quantity, 
keep  him  lying  down  with  his  head  on  a  low  pillow,  and 
try  to  keep  your  own  presence  of  mind,  and  cheer  him  up 
until  the  doctor  comes.  It  is  all  that  you  can  do. 

Blood-Vomiting. — The  first  thing  to  find  out  is  whether 
the  blood  that  is  vomited  comes  from  the  stomach  or  not. 
A  man  may  bleed  from  his  lung,  or  from  the  back  of  his 
nose,  and  the  blood  may  be  swallowed  and  afterwards 
vomited.  So  be  sure  to  notice  particularly  all  the  charac- 
ters of  the  blood  and  of  the  vomiting.  Tell  the  doctor  if  the 
blood  is  bright  red,  or  dark  red,  if  it  comes  into  the  hand- 
kerchief when  the  nose  is  blown,  and  whether  the  gums 
are  sore  or  not.  Blood  is  dark  red  and  clotted  if  it  comes 
from  the  stomach,  and  light  red  and  frothy  if  it  comes 
from  the  lungs.  The  more  accurately  you  can  describe 
to  the  doctor  all  the  details  of  vomiting,  and  its  relation 
to  food  and  drink,  the  more  accurate  is  his  advice  likely  to 
be,  and  the  more  speedily  he  will  be  able  to  begin  the  neces- 
sary treatment.  Until  the  doctor  comes,  keep  the  patient 
in  a  lying-down  position  and  let  him  suck  small  lumps  of  ice. 

Boils. — The  appearance  of  boils  usually  indicates  a  "run 
down"  condition.  Under  these  conditions  the  tendency  to 
the  occurrence  of  boils  is  increased  by  excessive  use  of 
tobacco  and  alcoholic  drinks  or  constipation.  They  are 


BREAST,  ABSCESS  OF  31 

exceedingly   common   in   people   suffering   from   diabetes. 

A  boil  is  an  abscess  of  the  skin — a  red,  painful,  in- 
flamed lump,  which  when  "ripe"  is  full  of  matter  called 
pus,  and  contains  a  "core,"  which  is  made  of  dead  tissue, 
and  must  be  got  rid  of  before  the  inflammation  will  heal. 

A  boil  may  sometimes  be  aborted  by  the  following  pro- 
cedures:— Take  a  cathartic  (calomel  followed  by  laxative 
salts),  scrub  the  inflamed  area  with  soap  and  hot  water, 
pull  out  any  hairs  near  the  central  area  and  apply  gauze 
soaked  in  bichloride  of  mercury  (1-000  in  50%  alcohol). 
Stop  smoking  and  drinking.  Further  aid  may  be  ob- 
tained by  the  inoculation  of  a  vaccine  (against  suppuration) 
by  a  physician. 

If  the  boil  comes  to  a  head  it  must  be  opened  by  a 
physician,  cleaned  out  and  drained.  Afterward  it  may 
be  necessary  to  take  sulphide  of  calcium  (gr.  1/10)  and  a 
tonic  of  iron  and  arsenic  with  a  course  of  vaccine  treat- 
ment. 

Brandy  and  Egg  Mixture  (EGG-NoGG). — Mix  together  the 
yolks  of  two  eggs,  half-an-ounce  of  refined  sugar,  two 
ounces  of  good  cognac  and  four  ounces  of  cinnamon  water. 

Breast,  Abscess  of  ("MILK- ABSCESS"). — Causes. — Ab- 
scess of  the  breast  rarely  occurs  except  during  suckling. 
A  cracked  nipple  is  generally  the  path  through  which  the 
germs  of  inflammation  get  into  the  breast  itself;  and  they 
are  able  to  set  up  inflammation  there  because  the  breast  is 
neglected  and  gets  too  full  of  milk,  owing  to  the  fact,  that 
the  nipple  being  sore,  the  baby  is  put  too  much  to  the  other 
breast.  This  is  very  bad  for  the  baby,  who  is  drawing  his 
very  life  from  the  other  breast. 

Treatment. — Whenever,  because  of  cracked  nipple,  or 
for  any  other  reason,  a  baby  does  not  make  use  of  one 
breast,  it  must  be  regularly  emptied  by  a  breast  pump, 
such  as  all  druggists  sell.  If  inflammation  is  beginning  and 
some  part  of  the  breast  is  getting  hard  and  tender,  let  the 
woman  purge  herself  well,  foment  the  breast  every  two  or 
three  hours,  and  support  the  breast  with  bandages  or  a 
sling  passed  round  the  neck  and  under  the  gland.  But  if 
an  abscess  seems  to  be  forming,  let  the  doctor  see  it  with- 
out delay,  for  an  early  incision  will  often  save  weeks  of 
pain  and  illness  and  avoid  the  formation  of  a  foul  and 
troublesome  ulcer. 


32  BBOKEN  BONES 

Breath,  Unpleasant  or  Foul. — This  may  be  the  result  of  un- 
healthiness  of  the  stomach  or  of  the  mouth  and  teeth.  The 
breath  of  a  person  whose  digestion  is  good,  and  who  keeps 
the  teeth  clean  is  quite  free  from  anything  objectionable. 
It  is  useless  to  try  and  cure  unpleasant  breath  with  cachous 
or  scented  lozenges,  so  long  as  the  food  is  not  masticated 
properly ;  or  if  too  much  alcohol  is  drunk,  too  much  smoking 
or  snuff-taking  is  indulged  in,  and  the  teeth  are  not  brushed 
regularly  every  night  at  bedtime.  (See  the  article  on  "  In- 
digestion" and  " Teeth.") 

BREATH,  SHORTNESS  OF. — This  may  occur  only  after  exer- 
tion, such  as  climbing  the  stairs,  or  it  may  be  always  present. 
Shortness  of  breath  may  be  spasmodic  (see  "Asthma,") 
or  continuous,  which  would  be  a  sign  of  heart  disease  or 
advanced  lung  disease,  or  chronic  bronchitis.  Shortness  of 
breath  on  exertion  in  young  girls  is  generally  due  to 
ancemia  (which  see),  or  to  heart  disease  caused  by  rheu- 
matism. In  older  people,  shortness  of  breath  on  exertion 
is  more  likely  to  be  due  to  a  "fatty  heart"  (perhaps  one 
of  the  results  of  tippling),  or  to  a  weak  flabby  heart  (after 
Influenza),  or  to  chronic  bronchitis.  In  the  last  case,  sul- 
phuric ether  taken  internally  in  small  doses  will  give  re- 
lief. 

The  reader  will  understand  that  there  is  no  royal  cure 
for  shortness  of  breath  itself.  We  must  first  discover  what 
it  is  caused  by,  and  treat  that  condition  appropriately. 
But  there  are  very  few  cases  of  shortness  of  breath  which 
a  doctor  cannot  greatly  relieve.  The  shortness  of  breath 
which  occurs  in  young  girls  is  very  amenable  to  treatment 
and  such  cases  should  never  be  neglected. 

Bright's  Disease. — Acute  Bright 's  disease  is  an  ailment 
in  which  the  kidneys  are  inflamed,  the  urine  scanty,  the 
eyelids  swollen,  and  albumin  is  passed  in  the  water.  It 
must  be  treated  by  a  doctor.  (See  "Kidney  Disease.") 

Broken  Bones. — If,  after  any  injury,  a  bone  is  thought 
to  be  broken,  a  doctor  can  not  be  seen  too  quickly.  It  is 
much  easier  to  replace  broken  bones  soon  after  the  accident 
than  later.  When  a  bone  is  broken  there  is  pain  at  the 
site  of  the  fracture  with  swelling,  tenderness  on  pressure, 
and  inability  to  use  the  part.  If  only  on-e  bone  of  the 
lower  arm  or  leg  is  broken  the  other  bone,  acting  as  a  splint, 
may  prevent  complete  loss  of  use. 

After  a  simple  fracture,  a  splint  of  a  thin  piece  of  board, 


BRONCHITIS  33 

covered  with  cotton,  should  be  applied  and  bound  firmly 
with  a  bandage. 

If  the  broken  end  of  the  bone  protrudes  through  the 
skin  (compound  fracture)  do  not  try  to  put  it  back  in 
place  before  the  doctor  arrives  as  it  has  been  infected  and 
unusual  precautions  are  required  to  prevent  the  forma- 
tion of  suppuration  and  an  abscess. 

Diagnosis  of  broken  bones  is  nowadays  practically  al- 
ways confirmed  by  the  X-rays. 

By  this  means  also  it  can  be  determined  whether  the 
broken  ends  have  been  replaced  in  the  proper  position. 

If  there  is  one  form  of  illness  for  which  Christian  Science 
is  not  fitted  to  treat  it  is  broken  bones. 

Broken  bones  require  from  three  to  six  weeks  to  heal, 
depending  upon  the  size  of  the  bone  and  the  age  of  the 
subject.  Some  fractures  in  old  people,  as  that  of  the  neck 
of  the  femur  at  the  hip,  heal  only  with  the  greatest  diffi- 
culty. 

Voluntary  motion  of  the  muscles  of  a  fractured  part  must 
be  begun  as  soon  as  possible,  otherwise  they  rapidly  shrink 
from  disuse  and  it  may  take  a  long  time  to  recover  the  use 
of  the  part. 

Bronchitis. — This  means  inflammation  of  the  air  tubes  in 
the  lungs  (see  also  ''Lung  Diseases").  It  is  a  catarrh  of 
the  air  tubes  just  as  a  cold  in  the  head  is  a  catarrh  of  the 
nose  and  throat  (see  also  "Cold  in  the  Head").  It  affects 
persons  of  all  ages,  from  infancy  to  old  age.  Its  chief 
symptom  is  a  cough  (see  also  "Coughs").  When  the 
disease  is  acute,  the  sufferer  has  much  fever  and  general 
illness,  but  the  cough  is  the  chief  feature.  At  first  it  is 
hard,  and  no  phlegm  is  coughed  up,  but  later  it  becomes 
easier  and  the  patient  spits  up  a  lot  of  yellowish  thick 
phlegm,  sometimes  tinged  with  blood. 

Acute  bronchitis  may  be  fatal,  and  must  be  treated  by 
a  doctor.  Chronic  bronchitis,  in  its  various  forms,  such  as 
a  "winter  cough,"  is  more  or  less  easy  to  relieve,  but  very 
difficult,  and  often  impossible,  to  cure.  The  patient  ought 
to  live  in  a  dry  climate,  or  failing  that,  a  warm  one.  He 
must  dress  warmly  and  keep  his  skin  active  with  frequent 
baths,  and  his  bowels  always  well  open.  There  are  three 
different  types  (among  others)  of  persons  with  chronic 
bronchitis. 

(1) — One  type  has  a  dry  catarrh,   a  painful  difficult 


34  BUBO 

cough  and  thick,  sticky  phlegm,  which  is  very  hard  to  get 
rid  of.  For  such  a  case  as  this  we  recommend: — Sodium 
iodide,  one  drachm;  sodium  bi-carbonate,  four  drachms; 
chloride  of  ammonium,  two  drachms;  solution  of  mor- 
phine, one  drachm;  chloroform  water,  eight  ounces.  Take 
a  teaspoonful  three  times  a  day. 

(2) — A  second  type  is  one  in  whom  there  is  a  lot  of 
coughing,  not  painful,  but  noisy,  and  plenty  of  watery 
phlegm.  Such  persons  would  be  benefited  by: — Tar  water 
(1  in  10),  a  wineglassful  of  half-a-pint,  twice  or  three  times 
a  day.  Sulphur  lozenges  and  Cod-liver  oil  are  also  useful 
in  such  cases. 

(3) — The  third  type  is  the  bronchitic  aged  person — old 
and  feeble,  and  wheezy.  A  good  remedy  consists  of  syrup 
of  tolu,  half  ounce;  ammoniacal  mixture  2  ounces;  com- 
pound tincture  of  camphor  3  drachms;  and  water  up  to  6 
ounces.  A  tablespoonful  may  be  given  thrice  daily,  or 
every  four  hours.  Petroleum  Emulsion  is  also  an  excellent 
remedy  given  after  meals. 

It  must  always  be  borne  in  mind  that  a  long  continued 
cough  which  is  difficult  to  cure  is  one  of  the  first  signs  of 
tuberculosis  or  consumption.  Therefore,  if  a  cough  has 
been  impossible  to  cure  after  three  or  four  weeks,  a  physi- 
cian should  be  consulted  to  make  sure  that  tuberculosis  is 
not  developing.  The  greatest  hope  for  cures  in  consump- 
tives lies  with  those  who  recognize  their  condition  the  earli- 
est. 

Prevention. — Much  can  now  be  done  to  prevent  the  oc- 
currence of  bronchitis  and  colds  and  consequently  tubercu- 
losis in  the  following  way : — 

Avoid  the  inhalation  of  dust.  Keep  up  the  resistance 
of  the  body  to  germ  invasion  by  cold  morning  baths,  out 
of  door  exercise,  nutritious  diet  without  excess  of  alcohol 
and  tobacco  and  avoidance  of  undue  fatigue. 

Bruises. — If  a  bruise  is  accompanied  by  breaking  of  the 
skin  it  should  be  cleaned  with  peroxide  of  hydrogen  and 
dressed  aseptically  until  the  skin  has  healed. 

If  the  skin  is  not  broken  it  may  be  rubbed  with  any 
healing,  soothing  lotion — such  as  belladonna  liniment — the 
most  efficacious  thing  being  the  massage  which  removes 
the  extravasated  blood  and  lymph  and  thus  diminishes  the 
swelling  and  consequent  pain. 

Bubo.— (See  "Glands.")     A  bubo  is  a  swollen  gland. 


BURNS  35 

The  word  is  generally  applied  to  the  glands  in  the  groin, 
swollen  as  a  complication  of  venereal  disease.  The  treat- 
ment is  surgical,  and  requires  skill  and  a  careful  use  of  dis- 
infectants. 

Bunion. — This  is  the  inflammatory  swelling  which  takes 
place  on  the  ball  of  the  great  toe  of  a  person  who  wears 
ill-shaped  boots.  Good  boots  are  straight  on  the  inner 
edge  and  not  cut  to  a  point.  The  remedy  lies  in  buying 
better-made  boots.  A  bad  bunion  may  require  a  little  op- 
eration called  ' '  excision  of  the  joint. ' ' 

Burns. — It  is  quite  evident  that  burns  of  the  body  may 
be  of  every  possible  variety  as  regards  extent  and  depth, 
If  a  hot  cinder  falls  on  one  '&  flesh  it  may  burn  a  deep  hole ; 
if  one's  clothes  catch  fire,  there  may  result  a  very  exten- 
sive burning  of  the  skin  only,  and  the  fat  and  muscles  be- 
neath may  not  be  damaged.  There  is  always  a  certain 
amount  of  " shock"  to  the  nervous  system  after  a  burn, 
and  the  greater  the  surface  burned  the  greater  will  be  the 
shock.  A  hot  coal  burning  a  hole  in  the  flesh  will  not 
shock  the  patient  so  greatly  as  a  surface  burn  of  any  part 
of  the  body. 

In  the  case  of  a  small  burn,  we  have  only  to  think  about 
the  burn,  and  how  to  get  it  well.  We  shall  consider  this 
first.  There  are  two  things  necessary  to  know: — First, 
how  to  keep  the  burned  part  clean  and  free  from  germs  of 
disease,  which  are  generally  floating  about  in  the  air,  and 
are  on  the  hands  and  clothes  of  everybody  in  cities  and 
towns;  and,  second,  how  to  relieve  the  dreadful  pain  and 
smarting,  and  to  keep  the  raw  place  free  from  all  mechan- 
ical irritation. 

First,  then,  remember,  that  flesh  or  skin  which  has  just 
been  burned  is  already  probably  quite  free  from  " germs," 
or,  as  doctors  say,  ''aseptic,"  because  fire  is  the  destroyer 
of  disease  germs.  So  that  it  is  our  duty  to  see  that  noth- 
ing that  can  possibly  be  contaminated  goes  anywhere  near 
the  burn.  Rags,  oil,  flour,  etc.,  are  all  very  well,  but  they 
may  not  be  "clean"  in  a  medicinal  sense.  Every  house- 
hold ought  to  have  a  little  packet  of  pure  boric  acid  powder 
in  the  cupboard,  and  this  should  be  dusted  over  the  burn. 
Blisters  should  be  pricked  with  a  darning  needle,  whose 
point  has  been  held  in  a  flame  for  half  a  minute,  and  the 
fluid  allowed  to  trickle  away  or  mopped  up  with  medi- 
cated cotton-wool.  Then  over  the  powdered  place  you  may 


36  BUST  DEVELOPMENT 

put  a  layer  of  medicated  cotton-wool  or  a  piece  of  boric 
lint.  In  any  case,  if  you  are  going  to  treat  the  burn  your- 
self, wash  your  hands  and  brush  the  nails  with  5  per  cent, 
carbolic  soap  before  you  begin.  Then,  even  if  the  burn 
does  not  heal  properly  and  there  is  a  lot  of  scarring,  you 
feel  that  you  have  done  your  best.  With  regard  to  scar- 
ring, do  not  forget  that  a  burn  on  the  face  or  hands,  or 
neck,  may  result  in  contraction  of  the  skin,  which  may 
disfigure  the  patient  and  spoil  his  looks  for  life. 

For  anything  but  a  trivial  burn,  a  doctor  must  be  called 
in.  No  one  else  can  apply  really  suitable  treatment  in  any 
given  case,  especially  if  medicines  are  required  in  addition. 
Some  like  oily  applications  for  burns,  and  use  carron  oil, 
composed  of  equal  parts  of  linseed  oil  and  lime  water. 

The  alkali  which  the  carron  oil  contains  neutralizes  the 
acid  from  the  burn  and  thus  prevents  the  pain  which  re- 
sults when  acid  is  applied  to  exposed  nerves. 

Some  physicians,  instead  of  using  oil,  prefer  to  expose 
burns  to  the  air,  neutralizing  the  acid  with  a  solution  of 
sodium  bicarbonate.  This  is  undoubtedly  preferable  for 
large  surface  burns  where  the  oxidizing  function  of  the 
skin  must  be  aided — not  interfered  with. 

Bust  Development. — Doctors  are  constantly  being  asked 
by  their  lady  patients  for  some  unobjectionable  method  of 
developing  their  figures.  That  being  so,  and  seeing  that 
there  are  numbers  of  expensive  preparations  advertised 
for  this  purpose  on  the  market,  we  give  our  readers  a  few 
hints.  Undeveloped  figures  are  generally  a  sign  of  poor 
nourishment,  and  the  first  thing  to  do  is  to  eat  only  the 
most  nourishing  food  and  attend  to  the  digestion  and  the 
state  of  the  teeth.  Eat  porridge,  plenty  of  bread  and 
cheese,  and  eggs,  and  milk,  and  puddings,  and  avoid  pic- 
kles and  nuts,  and  too  much  meat.  Breathing  exercises  are 
of  the  first  importance.  Every  morning,  before  breakfast, 
throw  open  the  window,  have  no  tight  bands  or  belts,  or 
braces  on,  stand  erect  with  heels  together  and  shoulders 
thrown  back,  and  fill  the  lungs  with  fresh  air,  slowly,  to 
their  utmost  extent.  When  full  of  air,  hold  it  in  as  long  as 
you  can,  and  then  breathe  it  slowly  out  again.  At  first  it 
will  tire  you,  but  persevere.  Do  it  fifteen  times,  then  lie 
down  quite  still  and  rest;  then  fifteen  times  again,  then 
continue  dressing.  After  three  weeks  your  lung  capacity 
will  be  much  improved  and  then  you  may  begin  to  fatten 


CANCER  37 

and  nourish  the  skin  of  the  neck,  shoulder  and  breasts. 
This  is  done  by  rubbing  in  the  following  preparation  for 
five  minutes  night  and  morning;  rub  gently  and  firmly, 
and  in  a  circular  direction,  with  the  palm  of  the  hand: — 
Elderflower  water,  half-a-pint;  simple  tincture  of  benzoin, 
half-an-ounce ;  tincture  of  myrrh,  a  few  drops ;  mix  well  and 
add  best  linseed  oil,  half-a-pint. 

The  intelligent  reader  will  understand  that  all  such 
methods  as  the  above  are,  though  often  highly  satisfactory, 
of  much  less  real  value  than  courses  of  suitable  gymnastics 
would  be.  It  is  better  to  be  in  good  muscular  condition  on 
the  chest  and  elsewhere,  than  to  be  merely  fat,  because  fat- 
ness varies  with  the  time  of  the  year  and  state  of  the 
health;  and  a  woman  with  suitably-developed  muscles  sel- 
dom lacks  a  comely  natural  covering  of  fat  and  a  healthy 
and  rosy  skin  in  addition. 

Cancer. — It  seems  to  be  a  fact  that  there  is  an  ever  in- 
creasing mortality  from  cancer  in  every  part  of  the  civi- 
lized world.  The  word  "cancer"  is  used  in  a  very  vague 
way,  almost  as  if  it  could  be  considered  interchangeable  or 
synonymous  with  "tumor."  Every  cancer  is  a  tumor, 
but  very  few  tumors  are  cancers.  "  Tumor"  means  a 
swelling,  and  nothing  more  than  that.  There  are  at  few- 
est ten  different  kinds  of  cancer,  and  they  vary  in  course, 
in  origin,  and  in  causation.  One  of  the  commonest  kinds 
of  cancer,  especially  in  males,  is  Epithelioma,  which  is  al- 
ways caused  by  mechanical  friction  of  a  part  in  a  predis- 
posed person,  and  is  nearly  always  preceded  by  an  ulcer 
of  that  part,  caused  very  often  by  excess  of  alcohol  or  to- 
bacco. Scirrhous  cancer  is  the  form  which  women  gener- 
ally have,  and  most  often  in  the  breast,  as  the  indirect 
result  of  a  blow  or  anything  else  which  may  hinder  the 
proper  performance  of  the  functions  of  that  organ.  Only 
10  or  11  per  cent,  of  women  affected  can  really  trace  the 
tumor  from  a  blow,  or  some  other  mechanical  violence. 
And  then  there  is  a  group  of  fatal  tumors  called  cancers 
by  the  public,  but  which  are  called  Sarcomas  by  the  doc- 
tors. Sarcomas  are  different  from  cancers  in  some  im- 
portant ways,  but  resemble  cancers  in  that,  if  not  removed 
in  time,  they  will  kill  the  patient.  A  malignant  growth, 
whether  Epithelioma,  Carcinoma,  Scirrhous,  Sarcoma,  or 
any  other  kind,  kills  the  patient  by  exhausting  his  strength, 
and  the  only  treatment  is  to  have  it  removed  by  operation, 


38  CARBUNCLE 

or  burnt  away  by  strong  caustics.  Even  then  it  may  come 
back  again  in  another  place,  and  if  the  other  place  is  one 
which  we  cannot  get  at  by  the  knife,  of  course  we  cannot  re- 
move the  tumor,  and  the  patient  must  die.  It  is  now  believed 
that  cancer  cells,  in  small  collections,  exist  in  many  people 
from  birth;  and  that  the  tendency  for  them  to  grow  into 
tumors  is  hereditary.  Not  everybody  who  has  a  few  can- 
cer cells  in  his  body  has  cancer,  however — a  tumor  may 
never  develop.  As  to  the  real  immediate  causes  of  cancer 
we  know  almost  nothing.  In  a  predisposed  person,  long- 
continued  mechanical  friction,  or  any  other  kind  of  me- 
chanical injury  will,  perhaps,  make  a  cancer  form;  and 
any  old  lump,  or  tumor,  or  sore,  may  become  cancerous,  if 
it  is  irritated  long  enough.  If  there  is  cancer  in  your 
family,  you  should  guard  against  neglecting  bruises,  blows, 
sores,  or  inflammations  of  every  kind;  and  you  should,  to 
be  quite  on  the  safe  side,  drink  no  alcohol  and  sn.oke  no 
tobacco.  It  cannot  be  shown  conclusively  that  cancer  has 
anything  to  do  with  food,  soil,  or  climate. 

Prevention: — A  large  proportion  of  the  deaths  by  can- 
cer could  be  avoided  if  the  cancerous  condition  were  rec- 
ognized early  enough  and  removed  soon  enough.  There- 
fore the  moment  a  suspicious  lump  is  observed  in  the 
breast,  a  sore  on  the  lip  which  will  not  heal,  indigestion 
which  will  not  improve,  or  if  there  are  evidences  of  blood 
from  the  uterus  which  cannot  be  explained  by  normal 
processes  lose  no  time  in  seeking  medical  advice  to  get  a 
diagnosis. 

Pain  is  one  of  the  most  common  symptoms  in  cancer, 
but  do  not  rely  on  this  symptom  alone  in  making  a  diogno- 
sis  of  cancer  for  it  is  sometimes  absent. 

Do  not  try  to  temporize  with  X-ray  and  blue  light  cures. 

You  may  be  losing  invaluable  time.  See  a  doctor  as  soon 
as  possible. 

Carbuncle. — This  is  a  large  boil,  affecting  several  glands 
in  a  group.  (See  also  "  Glands. ")  The  inflammation  is 
more  severe,  the  pain  is  greater,  and  there  is  more  general 
illness  than  with  ordinary  boils.  The  seat  of  the  trouble 
— the  skin  of  the  affected  part — is  raised,  firm,  bright,  red 
and  hot.  In  most  cases  the  inflammation  does  not  im- 
prove but  gets  worse  for  about  ten  days,  and  becomes  a 
brawny  red  painful  swelling,  on  the  back  of  the  neck,  or 
elsewhere.  Then  it  softens,  becomes  dotted  with  " heads" 


CATHETER  39 

or  yellow  points,  and  at  each  point  the  skin  gives  way  and 
yellow  blood-stained  pus  comes  out.  The  carbuncle  may 
even  then  continue  to  get  larger.  The  skin  between  the 
holes  dies  and  sloughs,  so  that  there  is  a  "core,"  and  a 
ragged  foul  ulcer.  The  nearest  glands  are  swollen  and 
tender  also,  and  the  patient  has  shivering,  aching,  fever, 
and  general  illness.  Death  may  occur  from  blood  poison- 
ing. 

It  occurs  sometimes  in  persons  of  robust  health,  because 
it  is  due  to  poisoning  by  germs,  but  weakly  people  are  more 
liable  to  be  attacked.  Many  cases  end  in  death  from  ex- 
haustion, especially  if  they  have  diabetes  as  well. 

The  treatment  of  a  small  carbuncle  is  the  same  as  for  a 
boil.  (See  "Boils.")  Paint  the  surface  of  the  skin  with 
glycerin  of  belladonna,  and  apply  hot  compresses.  The 
surgeon  must  be  called  in,  and  he  will  make  a  cross-shaped 
opening  with  his  knife,  and  let  out  as  much  of  the  poison 
as  possible.  The  cavity  will  have  to  be  scraped  and  mopped 
out  with  strong  germicides. 

But  besides  the  local  treatment,  the  patient  himself — it 
is  generally  a  man — will  require  treatment.  He  must  have, 
if  he  is  to  recover,  a  liberal  diet,  and  a  strong  tonic,  suited 
to  his  age  and  state  of  health.  Until  after  the  slough  has 
been  cleared  out,  he  ought  to  avoid  stimulants,  but  port 
wine  or  champagne  may  be  required  in  the  after-treatment. 
Afterwards  a  change  of  air  and  a  rest  are  most  neces- 
sary. 

Cataract.—  (See  "Eye  Diseases.")  If  you  read  the  first 
paragraph  on  eye  diseases  you  will  know  what  the  lens  is. 
A  cataract  is  an  opaque  spot  on  the  lens  of  the  eye.  It  is 
commonest  in  persons  over  fifty  as  one  of  the  forms  of  the 
decay  of  age.  Cataracts  in  young  persons  are  generally 
the  result  of  injuries  to  the  eye. 

Many  cataracts  can  be  removed  by  skillful  eye  surgeons, 
with  restoration  of  sight. 

Catarrh.—  (See  "Cold  in  the  Head.") 
Catheter. — A  catheter  is  a  tube  for  passing  into  the  blad- 
der to  draw  off  the  urine.  No  one  but  a  doctor  can  use 
the  instrument  properly,  but  sometimes  patients  have  to 
be  taught  to  pass  it  on  themselves,  because  they  are  unable 
to  pass  their  water  in  the  natural  way.  We  give  here  full 
medical  directions  as  to  how  to  treat  a  catheter,  which  has 
to  be  used  daily  by  the  patient  himself.  We  may  remark 


40  CHANCRE 

that  a  few  persons  regularly  use  a  catheter  without  taking 
any  precautions  whatever,  but  sooner  or  later  such  behavior 
is  always  disastrous.  An  unclean  catheter  takes  germs 
from  the  outside  air  into  the  bladder,  and  sets  up  inflam- 
mation there,  which  may  be  fatal. 

A  man  who  has  to  use  a  catheter  regularly  should  use  a 
red  rubber  one  generally,  and  a  gum-elastic  one  only  when 
absolutely  necessary.  The  smallest  roughness  or  fraying  of 
the  catheter  should  cause  it  to  be  discarded.  Have  a  bottle 
of  a  pint  of  1  in  2,000  corrosive  sublimate  lotion ;  it  is  quite 
cheap  and  the  drug  is  sold  in  tabloid  form.  Wash  the 
hands  with  carbolic  soap  before  handling  the  catheter,  and 
the  privates  also,  whenever  practicable,  before  pushing  the 
catheter  into  the  bladder.  Let  the  catheter  lie  in  the  lotion 
for  five  minutes  before  use,  and  then  lubricate  it  with  1  in 
40  carbolic  oil.  It  is  a  good  plan  to  squirt  some  lotion 
through  the  catheter  (with  a  glass  syringe  kept  for  the  pur- 
pose) before  introducing  it. 

After  use,  the  catheter  ought  to  be  washed  with  soap  and 
water,  and  lotion  run  through  it.  Then  roll  it  in  a  piece 
of  boric  lint  and  keep  it  in  clean  paper  until  wanted  again. 
If  these  precautions  are  taken,  a  man  may  go  on  using  the 
catheter  daily  for  years  without  risk.  If  such  precautions 
are  neglected,  the  patient  may  at  any  time  contract  a  ca- 
tarrh of  the  bladder  or  something  even  more  serious. 

Chancre. — This  word  means  a  sore,  caused  by  the  poison 
of  a  venereal  disease.  There  are  two  types  of  chancre,  the 
soft  and  the  hard.  The  soft  sore  is  a  local  disease,  it  de- 
velops from  a  pimple  which  appears  within  a  few  hours 
and  gets  well,  if  properly  treated,  in  a  few  weeks.  But 
the  glands  in  the  groin  may  enlarge  and  become  an  abscess 
called  a  bubo.  This  disease  is  curable,  and  no  ill-effects 
are  transmitted  to  the  children.  But  it  is  intensely  con- 
tagious. The  hard  sore,  on  the  other  hand,  is  nothing  more 
nor  less  than  the  first  stage  of  the  dreadful  disease  called 
syphilis  (which  see).  This  sore  develops  in  from  two  to 
three  weeks.  The  disease  lasts  for  two  years  at  least,  and 
can  be  transmitted  to  the  innocent  children  of  marriage, 
as  well  as  to  the  wife. 

Upon  the  development  of  such  a  chancre  the  man  or 
woman  must  immediately  place  him-  or  herself  under 
good  medical  advice.  They  not  only  owe  it  to  themselves 
to  get  well,  but  it  should  be  their  greatest  concern  that  they 


CHANGE  OF  AIR  41 

do  not  further  spread  the  disease.  This  might  be  done  by 
direct  contact  of  the  parts  or  later,  through  other  disease 
conditions  in  the  mouth,  through  common  drinking  cups 
and  eating  utensils. 

The  best  way  to  avoid  the  inconvenience  and  agony  of 
this  disease  is  by  not  contracting  it;  and  the  best  way  to 
avoid  contracting  it  is  by  leading  a  clean  moral  life. 

To  try  to  treat  a  disease  like  chancre  or  syphilis  by 
Christian  Science  is  one  of  the  greatest  crimes  of  modern 
times. 

Change  of  Air. — Nowadays  we  all  say  we  want  a  change 
of  air  and  a  holiday  occasionally,  but  our  grandfathers 
tell  us  that  they  did  not  want,  and  did  not  get,  trips  to  the 
seaside,  nor  holidays  from  Saturday  to  Monday,  nor  any 
long  autumn  vacation,  but  they  kept  on  at  the  same  work 
year  after  year.  What  is  the  reason  for  this  change? 
Are  we  less  vigorous  than  our  forefathers?  Or  do  we 
work  harder  and  have  more  worries  than  they  did? 
There  are  reformers  who  tell  us  that  we  are  a  degenerate 
race,  and  there  seems  much  evidence  in  favor  of  that  view ; 
and  there  is  an  easy  explanation  offered  for  our  accept- 
ance. Modern  improvements  in  medicine  and  surgery  have 
saved  thousands  of  invalid  lives  during  the  last  fifty  years, 
and  these  thousands  of  unhealthy  persons  have  had  fam- 
ilies, and  their  children  are  more  or  less  tainted  by  hered- 
ity of  scrofula,  tubercle,  or  some  other  form  of  blood- 
poisoning.  Whatever  may  be  the  cause,  we  moderns  do 
really  need  rest  and  change  very  frequently,  and  it  is  wise 
to  consider  how  to  get  the  best  effect  out  of  our  oppor- 
tunities. It  is  quite  certain  that  persons  of  ample  means 
who  can  go  away  for  a  month  to  a  health  resort  or  to  a 
seaside  village,  or  who  can  go  for  a  sea  voyage  under  com- 
fortable circumstances,  will  derive  great  benefit  there- 
from. It  is,  however,  quite  a  different  matter  for  the  poor 
worker,  who  has  to  stint  himself  in  his  ordinary  mode  of 
life  in  order  to  get  away  from  his  home  at  all.  Most  of  us 
love  pleasure  and  change  for  their  own  sake,  and  we  are 
apt  to  take  them  without  much  concern  as  to  whether  we 
shall  really  benefit  in  health.  The  average  man  is  very 
apt  to  overdo  his  pleasures  when  he  gets  out  of  harness, 
and  may  certainly  drink  too  much  when  on  a  holiday.  Our 
railways  offer  us  very  tempting  short  excursions,  but  we 
are  apt  to  find  ourselves  tired  and  exhausted  after  a  long 


42  CHANGE  OF  AIR 

railway  journey  in  a  crowded  railway  train.  Persons  who 
do  not  travel  often  in  trains  frequently  catch  severe  colds 
when  the  weather  is  unfavorable ;  and  the  seaside  lodgings 
to  which  the  middle  class  and  poor  traveler  have  to  go  are 
often  small,  poky,  dirty,  and  badly  ventilated,  and  land- 
ladies frequently  prepare  meals  less  carefully  than  the 
housewife  does  for  her  family  at  home.  The  unfortunate 
result  is  that  a  holiday  away  from  home  does  not  always  do 
all  the  good  that  is  expected  of  it. 

Change  of  Air  as  a  Remedy. — Apart  from  drugs,  there  is 
no  remedy  of  greater  service  to  the  invalid,  the  convales- 
cent, and  delicate  person,  than  change  of  air.  Change  of 
scene  and  occupation  are  also  valuable  in  the  treatment  of 
many  minor  ailments.  For  almost  all  complaints  a  change 
to  the  seaside  is  likely  to  produce  improvement,  if  adopted 
after  the  disappearance  of  all  acute  symptoms.  Sea  air  is 
more  full  of  ozone,  and  is  slightly  saline,  and  is  notable 
for  improving  the  appetite  and  for  giving  tone  to  the 
nervous  system.  To  the  town  dweller,  and  especially  to 
those  who  have  to  work  long  days  in  factories  and  close 
rooms,  the  fresh  sea  air  is  life-giving;  and  even  a  few 
hours  of  life  on  the  seacoast  blows  all  impure  air  out  of 
the  lungs,  and  so  does  much  to  purify  the  blood.  The 
pure  air  of  the  countryside  inland,  far  from  towns  and 
factories,  is  often  of  almost  equal  value  as  a  tonic  remedy 
to  one  who  is  recovering  from  an  exhausting  illness. 
There  are  also  thousands  of  persons  who  are  of  a  scrofulous 
or  tuberculous  constitution,  and  children  with  rickets, 
who  are  hardly  able  to  survive  in  towns.  These  will  often 
grow  up  stronger,  and  even  hardy,  if  removed  to  country 
villages  or  to  the  seaside.  Country-born  and  bred  persons 
are  always  superior  in  vitality  to  town  dwellers,  and  this 
is  one  reason  why  it  is  such  a  national  misfortune  that  the 
present-day  tendency  is  for  the  young  to  desert  country 
life  and  open-air  occupations  in  favor  of  the  town  employ- 
ments, which  are  never  so  healthy  or  free  from  risk. 
Town  dwellers,  accustomed  to  narrow  streets  and  courts, 
often  have  a  notion  that  they  would  be  more  liable  to  ill- 
nesses from  catching  cold;  but  this  is  a  mistaken  idea,  for 
open-air  life  for  a  month  renders  persons  much  less  liable 
to  catch  chills  than  they  ever  were  before.  The  winds 
from  open  fields  are  much  less  dangerous  than  the  draughts 
of  air  met  with  at  street  corners  in  towns.  Persons  who 


CHANGE  OF  LIFE  43 

in  London  catch  a  cold  if  they,  for  an  exception,  ride  out- 
side an  omnibus,  will  not  be  made  ill  by  a  long  ride  on 
a  coach  among  the  Welsh  or  Scotch  hills,  because  the  air 
is  purer  and  freer  from  germs.  Delicate  children  should 
always  be  sent  away  from  town  for  a  long  visit  to  country 
relatives,  whenever  it  is  possible,  and  quick  recoveries  will 
often  be  found  to  occur  after  whooping  cough,  diphtheria, 
enlarged  glands  and  rickets,  if  treated  by  a  three  to  six 
months'  country  residence. 

Change  of  Life. — (MENOPAUSE,  CLIMACTERIC,  THE 
CHANGE.) — This  is  the  time  of  life  in  a  woman  when  she 
ceases  to  menstruate  (see  "Menstruation"),  and,  as  a  rule, 
becomes  incapable  of  bearing  children.  This  change  oc- 
curs between  the  ages  of  45  and  50,  and  sometimes  comes 
on  abruptly  and  suddenly,  but  in  other  women  it  is  more 
gradual  and  sometimes  accompanied  by  great  loss  of 
blood. 

This  change  of  life  is  a  very  critical  period  in  the  life 
of  every  woman.  Every  part  of  her  seems  to  share  in  the 
general  disturbance.  Her  bodily  organs  are  all  more  likely 
than  ever  to  become  disordered,  and  hardly  any  woman 
escapes  some  ill-health  at  this  time.  Headaches,  flushings, 
giddiness,  and  loss  of  blood  are  common.  Great  irritabil- 
ity of  temper,  over-sensitiveness,  fancifulness,  wrong- 
headed  suspiciousness,  unseemly  behavior  and  coarse  con- 
versation, all  these  are  characteristic  of  even  the  most  ami- 
able and  respected  women  at  their  change  of  life. 

If  any  germs  of  disease  exist  in  a  woman,  they  will  often 
develop  at  a  fearful  rate  at  "the  change,"  and  women 
ought  not  to  neglect  to  take  medical  advice  at  that  time. 
It  is  impossible  to  map  out  any  line  of  treatment  for  a  con- 
dition which  varies  so  greatly  in  different  women,  but  it  is 
always  a  safe  rule  to  keep  the  bowels  and  skin  acting  very 
freely  and  to  avoid  excitement  and  late  hours,  and  especially 
to  avoid  alcoholic  drinks. 

It  should  be  borne  in  mind  by  all  husbands,  and,  in  fact, 
by  all  adults,  that  a  woman,  heretofore  reasonable,  amiable, 
lovable,  and  just,  may,  at  the  change  of  life,  become  tem- 
porarily ill-tempered,  unreasonable,  wildly  and  absurdly 
jealous,  and  unjust;  these  things  are  to  some  extent  beyond 
her  control,  and  she  must  be  treated  with  the  patience  and 
forbearance  which  are  shown  to  invalids  and  children.  A 
"sweet  reasonableness"  must  not  be  expected  of  her, 


44  CHEST,  DEFORMITIES  OF 

though  she  is  unable,  in  many  cases,  to  see  that  there  is 
anything  unusual  in  herself. 

Chest,  Deformities  of. — A  healthy  chest  is  well-rounded 
in  every  way;  it  is  covered  with  a  fair  layer  of  skin  fat 
and  no  bony  points  project;  the  shoulder  blades  lie  against 
the  back  of  it  and  are  covered  with  firm  muscle.  The 
grooves  between  the  ribs  can  hardly  be  seen.  In  section 
such  a  chest  is  oval,  slightly  flattened  behind.  Such  is  the 
healthy  chest  containing  healthy  lungs  and  a  strong  heart. 
If  the  chest  has  a  shape  different  to  that,  it  may,  perhaps, 
still  contain  healthy  lungs,  but  those  lungs  are  very  liable 
to  disease.  The  different  kinds  of  deformed  chests  are 
these : — 

Flat  Chest. — This  is  either  due  to  undevelopment  or  to 
lung  disease.  The  chest  is  flat  instead  of  rounded,  the 
ribs  are  too  straight  and  there  is  not  much  room  inside  for 
the  lungs  to  expand.  Such  a  chest  may  be  greatly  im- 
proved by  the  regular  use  of  a  "developer." 

Pigeon-breast. — The  cross-section  of  such  a  chest  is  tri- 
angular, the  breast  bone  forming  a  sort  of  keel  in  front, 
as  it  does  in  the  breast  of  a  pigeon.  The  ribs  are  flattened 
to  the  sides.  The  cause  of  this  deformity  is  some  obstruc- 
tion to  breathing  in  infancy,  so  that  the  lungs  have  not 
been  properly  filled  with  air.  Such  obstruction  may  be 
adenoids  or  enlarged  tonsils.  (See  "Adenoids.") 

Bulging  of  one  side  of  the  Chest  is  caused  by  lateral 
curvature  or  twisting  of  the  spine  on  its  axis. 

Rickety  Chest. — This  is  very  characteristic,  and  is  one  of 
the  effects  of  rickets  in  childhood.  The  ribs  are  too  soft 
while  the  lungs  are  developing,  and  so  they  yield  at  the 
weakest  parts  and  form  two  grooves  down  each  side  of  the 
body;  and  there  is  a  row  of  knobs  down  each  side  of  the 
breastbone  where  the  ribs  join  it,  knobs  which  are  caused 
by  rickety  enlargements  of  the  ends  of  the  bones.  The 
lower  part  of  the  chest  is  apt  to  bulge  from  lying  over  the 
liver.  Such  a  chest,  though  ugly  and  misshapen,  is  not  es- 
pecially prone  to  disease. 

Barrel  Chest— (see  "Strong,  How  to  Become.")— This 
deformity  consists  of  an  undue  roundness  of  the  chest,  the 
result  of  blown-out  and  inelastic  lungs.  The  chest  is  too 
short,  the  ribs  too  horizontal,  and  the  shoulders  raised. 

Long  Chest. — This  is  the  opposite  of  barrel-shaped.  The 
ribs  slope  down,  the  neck  is  long,  the  throat  prominent, 


CHILBLAINS  45 

and  the  shoulder  blades  stand  out  behind  like  wings.  The 
lungs  inside  such  a  chest  never  are,  and  never  have  been 
properly  expanded,  and  are  very  prone  to  become  tuber- 
culous— "consumptive."  The  deformity  is  curable  by  the 
correct  use  of  a  "developer." 

Chicken-pox. — The  medical  name  is  Varicella.  It  is  quite 
distinct  from  smallpox,  which,  however,  it  resembles  some- 
what. Chicken-pox  develops  about  a  fortnight  after  ex- 
posure to  infection.  It  is  not  very  contagious.  There  is  a 
rash  which  comes  out  on  the  first  day  of  illness,  in  succes- 
sive crops  of  small  pimples,  on  the  chest,  mostly,  but  also 
on  the  face.  There  may  be  a  little  fever.  Death  almost 
never  results  from  chicken-pox. 

The  rash  is  characteristic;  it  consists  of  pink  pimples, 
which  become  blebs  containing  watery  fluid  in  about  twelve 
hours.  In  a  few  hours  more  the  fluid  becomes  milky  in 
appearance  and  then  the  spots  begin  to  dry  up,  and  the 
pink  ring  round  them  gradually  fades.  A  few  of  the  pocks 
leave  small  whitish  scars. 

Treatment. — Light  diet,  isolation,  and  attention  to  the 
bowels  are  all  that  are  necessary.  The  child  must  be  pre- 
vented from  scratching  the  spots.  The  itching  may  be  re- 
lieved with  a  weak  lotion  of  camphor  water  and  carbolic 
acid,  which  any  good  druggist  will  supply. 

Chilblains. — Nearly  everyone  is  familiar  with  the  ap- 
pearance of  chilblains,  and  a  very  large  number  of  people 
whose  circulation  is  weak  suffer  from  them  every  winter. 
The  skin  affected  with  a  chilblain  is  tender,  and  itches 
abominably  as  soon  as  it  gets  warm.  As  the  inflammation 
goes  down  there  is  generally  some  shedding  of  the  skin. 
In  underfed  and  scrofulous  children  the  skin  of  a  chil- 
blain sometimes  breaks  into  a  painful  ulcer  or  sore,  which 
is  very  difficult  to  heal.  A  further  stage  in  the  same 
process  is  frostbite,  in  which  the  part  gets  at  last  swollen 
and  almost  violet  in  color  and  little  blebs  form. 

We  must  not  forget  that  though  chilblain  is  a  local  dis- 
order, it  is  due  to  bad  circulation  of  the  blood,  and  this  is 
often  accompanied  by  poorness  of  the  blood,  which  is  what 
doctors  call  anaemia ;  so  that  it  may  be  necessary  to  get  the 
doctor  to  prescribe  tonics  and  blood-forming  foods,  par- 
ticularly cod  oil  and  malt,  as  well  as  to  treat  the  chilblain 
locally. 

The  chief  thing  is  to  stimulate  the  circulation  of  the 


46  CHOKING 

blood  in  the  affected  parts.  For  this  purpose  the  parts 
must  be  kept  warm.  If  the  hands  are  affected,  mittens  or 
knitted  woolen  gloves  must  be  worn  continually,  and,  un- 
less the  feet  are  disabled  by  pain  and  swelling,  plenty  of 
walking  must  be  done,  and  the  feet  and  legs  must  be  kept 
warm  with  woolen  worsted  stockings.  After  washing  it  is 
important  to  dry  the  parts  as  thoroughly  as  possible  and 
to  rub  the  chilblain  with  a  rough  towel.  Friction  is  al- 
ways useful  if  it  can  be  borne.  For  painting  on  the  chil- 
blain there  are  three  useful  remedies — tincture  of  iodine, 
spirits  of  camphor  and  friar's  balsam — all  homely  med- 
icines. 

If  the  skin  breaks  the  ulcer  must  be  treated  as  any 
other  ulcer,  but  it  is  better  to  let  a  doctor  treat  it,  because 
chilblain  ulcers  do  not  heal  at  all  easily. 

If  the  chilblain  ever  becomes  a  real  frostbite,  the  only 
way  is  to  rub  it  with  snow  until  the  circulation  is  restored. 
If  you  warm  it  rapidly  at  a  fire  you  may  lose  a  finger  or 
nose  from  mortification.  And  all  persons  who  are  subject 
to  chilblains  are  likely  to  be  benefited  by  taking  ichthyol  as 
a  medicine.  (See  also  "Skin  Diseases"  II.) 

Child  Crowing. — The  other  common  name  for  this  is  spas- 
modic croup ;  the  medical  name  is  Laryngismus.  The 
symptoms  of  the  ailment  are — twitching  of  hands  and  face 
(which  may  occur  even  during  sleep),  and  a  sudden  great 
difficulty  of  breathing,  so  that  the  child  gets  terrified  and 
runs  to  its  mother.  The  spasm  ends  as  suddenly  as  it  be- 
gan, with  a  loud  crowing  noise.  Sometimes  children  die 
in  the  attack  without  having  uttered  a  sound,  though  this 
is  rare. 

Treatment. — It  is  especially  rickety  children,  and  those 
with  worms,  who  get  these  spasmodic  attacks.  The  doctor 
ought  to  be  asked  for  advice  as  soon  as  the  first  one  occurs. 
If  a  bad  attack  comes  on,  put  the  child  into  a  warm  bath, 
or  if  none  is  ready,  dash  cold  water  on  its  face  and  head, 
and  tickle  the  back  of  the  throat  with  a  finger,  to  make  it 
sick.  Further  treatment  must  be  by  medicine  ordered  by 
the  doctor.  (See  also  "Croup.") 

Choking. — This  may  be  caused  by  something  which  ob- 
structs the  air  passages,  a  piece  of  food,  a  * '  plate ' '  of  false 
teeth,  a  marble,  or  a  toy;  or  by  a  sudden  swelling  of  the 
passages  themselves,  as  happens  after  swallowing  certain 
poisons,  in  diphtheria,  and  occasionally  in  chronic  Bright 's 


CHOLERA  47 

disease.  Or  the  throat  muscles  may  be  paralyzed  and 
lumps  of  food  may  get  into  the  windpipe  instead  of  slip- 
ping easily  down  the  gullet. 

Everyone  recognizes  choking,  there  is  no  need  to  describe 
it.  If  a  child  chokes,  and  coughs  vigorously,  let  him  alone, 
but  put  a  cup  of  water  or  tea  in  his  reach,  so  that  when  he 
is  ready  he  can  wash  the  lump  down.  If  the  coughing  is 
feeble  and  the  face  is  getting  dusky,  slap  him  on  the  back, 
giving  him  a  slap  in  time  with  each  effort  of  coughing. 
Do  not  get  excited,  however.  But  if  he  really  seems  to  be 
suffocating  (and  this  takes  a  little  time  to  happen),  force 
his  teeth  open,  hold  them  open  with  the  knife  handle,  and 
sweep  the  finger  along  the  back  of  the  mouth  from  side  to 
side.  If  the  child  is  very  small,  turning  it  upside  down 
and  holding  it  up  by  the  feet  is  very  good  practice. 

If  suffocation  seems  to  have  taken  place  already  and  the 
child  is  livid  and  seems  dead — if  the  doctor  has  not  yet  ar- 
rived— the  child's  only  chance  is  to  open  the  windpipe 
and  let  the  air  in  through  a  hole.  Take  a  sharp-pointed 
penknife,  or  one  blade  of  a  pair  of  scissors,  feel  for 
''Adam's  apple"  in  the  throat,  and  then  push  the  knife  in 
just  below  it,  and  keeping  exactly  in  the  middle  line,  and 
having  opened  the  windpipe  enlarge  the  wound  downwards 
a  little.  Air  will  rush  into  the  windpipe  and  lungs,  if  you 
have  been  quick  enough,  and  you  have  saved  his  life.  You 
may  need  to  hold  open  the  windpipe  wound  with  the  scis- 
sors blades.  But  more  likely  the  obstructing  lump  of  food 
will  be  coughed  up  then  and  all  will  be  well. 

In  cases  of  choking,  where  the  throat  is  swollen,  the  same 
opening  of  the  windpipe  may  be  necessary.  A  person  who 
swallows  boiling  tea  or  soup  by  mistake  may  get  an  in- 
tensely swollen  throat  and  may  choke.  Nothing  can  be 
done  without  a  doctor's  advice. 

Cholera. — This  term  is  used  to  describe  three  entirely 
different  conditions,  namely,  cholera  infantum,  cholera 
morbus  and  Asiatic  cholera.  The  last  is  the  epidemic  form. 

Cholera  infantum. — Is  an  acute  disease  of  childhood 
characterized  by  high  fever,  vomiting,  purging  and  col- 
lapse, caused  largely  by  hot  weather,  faulty  feeding,  denti- 
tion and  bad  hygiene. 

This  is  a  very  serious  condition  and  calls  for  prompt 
treatment,  preferably  by  a  physician. 

Treatment  consists  of  fresh  air,  coolness,  laudanum  in 


48  CLEANING 

very  small  doses  to  arrest  diarrhea,  brandy  to  counteract 
collapse,  with  bowel  irrigations. 

Barley  water  and  beef  juice  are  relied  on  for  nourish- 
ment as  soon  as  the  stomach  can  retain  food. 

Prevention. — During  the  hot  summer  months  give  the 
child  only  breast  or  pasteurized  milk  and  meats  and  fruits 
of  undoubted  freshness. 

Cholera  Mor~bus. — An  acute  disease  resembling  true  chol- 
era but  rarely  ending  fatally,  usually  caused  by  eating 
partially  decayed  meat  or  fruit. 

It  is  characterized  by  intense  cramps  in  the  stomach, 
vomiting,  purging,  fever  and  great  prostration. 

Give  a  dose  of  castor  oil  if  it  can  be  retained,  brandy  for 
the  prostration,  morphine  by  hypodermic  injection,  hot  ap- 
plications to  the  abdomen  and  ice  for  the  thirst. 

Asiatic  Cholera. — True  Asiatic  cholera,  which  is  always 
more  or  less  prevalent  in  India,  China  and  Arabia,  has 
lately  reached  our  thresholds.  Prevention  is  the  most  im- 
portant measure  for  us  to  observe.  Preventive  measures 
consist  in  having  efficient  quarantine  officers,  with  quaran- 
tine of  suspicious  cases.  As  cholera  is  a  water-borne  dis- 
ease freedom  from  contracting  it  is  usually  assured  by 
using  only  boiled  and  filtered  water  and  eating  no  uncooked 
food.  Discharges  from  suspicious  cases  should  be  disin- 
fected. 

An  attack  of  cholera  is  marked  by  the  sudden  onset  of 
pain  and  spasms  in  the  bowels,  vomiting  and  diarrhea  of 
thin  rice-water-looking  stools  followed  by  great  collapse 
and  death  in  50  per  cent,  of  the  cases. 

In  any  suspicious  case  a  physician  should  be  called  at  the 
earliest  possible  moment. 

Circumcision. — This  means  the  removal  of  the  foreskin 
of  the  male.  The  little  operation  is  performed  on  every 
Jewish  and  Mohammedan  male  child  as  a  religious  rite. 
It  certainly  promotes  local  cleanliness  and  lessens  the  risk 
of  local  disease.  Every  qualified  medical  practitioner  is 
competent  to  perform  circumcision.  The  parts  will  be 
healed  in  about  a  week,  but  will  take  longer  in  the  case  of 
an  adult.  The  operation  is  often  performed  to  cure  bed- 
wetting. 

Cleaning. — A  large  number  of  the  infectious  or  germ  dis- 
eases are  contracted  by  inhaling  the  germs  in  the  dust.  It 


CLEANING  49 

is  of  the  greatest  importance  therefore  that  in  homes,  and 
places  where  people  gather  in  large  numbers  this  source 
of  disease  should  be  reduced  to  the  smallest  possible  pro- 
portions. 

As  the  weekly  body  bath  of  our  ancestors  has  given  way 
to  the  daily  bath  of  our  time,  so  has  the  dreaded  cataclasm 
known  as  ''spring  house  cleaning"  given  way  to  our  daily 
or  weekly  cleaning.  This  has  been  rendered  possible 
largely  by  the  use  of  the  modern  vacuum  cleaner,  by  the 
use  of  which  carpets,  floors,  mattresses,  furniture  and  cur- 
tains can  be  thoroughly  cleaned  without  removing  them 
from  their  regular  positions. 

Almost  worse  than  no  cleaning  or  dusting  is  the  use  of 
the  feather  duster,  which  simply  stirs  up  the  dust,  making 
it  easier  to  inhale,  and  never  doing  more  than  moving  it 
from  one  place  to  another.  If  the  vacuum  method  of 
cleaning  is  not  available,  the  feather  duster  may  be  re- 
placed by  moist  cloths,  or  moist  saw  dust  on  the  floors, 
which  will  prevent  'dust  from  flying  about  during  the 
process  of  sweeping. 

Rooms  containing  the  least  number  of  dust-catchers  are 
the  most  sanitary  and  healthiest,  and  hard  wood  floors 
with  rugs  are  preferable  to  carpets. 

In  cleaning  parquet  flooring  care  should  be  taken  to 
clean  the  floor  first  with  "paille  de  fer"  which  can  be 
bought  for  a  few  cents.  This  can  be  rubbed  on  the  floor 
with  the  foot  to  take  out  all  grease  and  other  stains  before 
applying  floor  wax.  Butchers  floor  wax  polish  is  the  most 
satisfactory  as  it  leaves  no  oil. 

In  cleaning  furniture  or  any  wood  with  polished  surface, 
the  best  article  is  that  known  as  "The  Japanese  Furniture 
Polish." 

White  painted  surfaces,  if  soiled  or  greasy,  should  be 
wiped  over  lightly  with  a  cloth  dampened  with  turpentine 
and  wiped  with  the  grain  of  the  wood. 

For  the  floors  of  public  buildings  the  use  of  such  sub- 
stances as  Standard  Floor  Dressing  is  recommended  to 
allay  dust  and  promote  cleanliness. 

For  ordinary  flooring  no  better  initial  form  of  cleaning 
has  ever  been  devised  than  the  occasional  old-fashioned 
scrubbing  with  soap,  water  and  scrubbing  brush  with  use 
of  a  mop,  provided  that  these  articles  are  subsequently 


50  CLIMATE  FOR  INVALIDS 

properly  disposed  of  or  cleaned,  so  that  the  germs  they  have 
collected  cannot  again  become  free  and  escape  into  the  air. 

Climate  for  Invalids. — There  is  no  model  or  perfect 
climate  in  the  world;  none  which  will  suit  every  kind  of 
invalid.  The  dry  ones  have  wind  and  dust;  the  moist, 
warm  ones  have  malaria,  and  are  relaxing;  the  cold,  dry 
ones  are  not  thus  all  the  year  round.  If  you  want  luxuri- 
ant vegetation  and  scenic  beauty  of  that  kind,  then  you 
find  that  the  climate  must  be  hot  and  damp,  a  very  bad 
climate  for  nearly  all  consumptives.  Sea  air  is  excellent 
for  many  people,  but  does  some  asthmatic  people  much 
harm,  and  neuralgic  people  are  very  liable  to  be  in  pain  at 
the  seaside. 

People  with  shattered  constitutions  ought  to  avoid  warm, 
relaxing  climates  like  the  Florida  Coast  Resorts  and  choose 
places  like  Redlands  and  Riverside  ( Cal. ) ,  Aiken,  Asheville, 
Virginia  Hot  Springs,  Lakewood,  St.  Lawrence  River, 
Bermuda  or  the  Hawaiian  Islands. 

Nervous,  excitable  people  should  avoid  such  climates  as 
those  of  Colorado,  Idaho,  and  Wyoming. 

A  choice  of  climates  for  a  few  of  the  common  diseases 
follows : — 

Pulmonary  Tuberculosis. — Arizona,  New  Mexico,  Sierra 
Madre  (Cal.),  Colorado  Springs,  Adirondacks,  Asheville, 
San  Moritz  (Switzerland). 

Nervous,  Excitable  People. — Bermuda,  Jamaica,  Cuba, 
Florida  Coast  Resorts,  Hawaii,  Southern  California,  Ashe- 
ville, Aiken,  Old  Point  Comfort,  Atlantic  City,  Lakewood. 

Neurasthenia. — Yellowstone,  Yosemite,  Grand  Canyon  of 
the  Colorado,  Niagara,  Great  Lakes,  Canadian  Rockies, 
White  Mountains,  Maine  Woods,  St.  Lawrence  River,  Mex- 
ico, Bermuda,  and  foreign  travel. 

Heart  Disease. — Watkins  Glen  Springs. 

Rheumatism. — Virginia  Hot  Springs,  Mt.  Clemens 
(Mich.),  Watkins  Glen  Springs,  Saratoga  Springs,  Paso 
Robles  and  Glenwood  ( Col. ) ,  Richfield,  and  Poland  Springs. 

Convalesence. — Lakewood,  Atlantic  City,  Aiken,  Vir- 
ginia Hot  Springs,  Southern  California,  Bermuda. 

Liver,  Skin  and  Digestive  Disturbances. — Saratoga,  Rich- 
field, Arkansas  Hot,  French  Lick  and  Poland  Springs. 


HEALTH  RESORTS  51 


HEALTH  RESORTS. 

Adirondacks. — General  elevation,  1,500  to  2,000  feet. 
Climate  cool.  Large  number  of  cloudy  days  with  high 
humidity.  Soil — light  and  sandy.  Tree  growth — pine,  bal- 
sam, spruce,  and  hemlock. 

Popular  for  the  treatment  of  pulmonary  diseases  of  tu- 
bercular origin. 

Best  known  resorts  are  Saranac,  Ampersand,  Paul 
Smiths,  Lake  Placid,  Blue  Mountain  Lake,  Raquette  Lake, 
Keene  Valley,  and  Adirondack  Lodge. 

Aiken. — Near  the  Georgia  line  in  South  Carolina.  Ele- 
vation, 500  feet.  Pine  country  with  sandy  soil.  Few 
rainy  days  and  comfortable  winter  climate.  Desirable  for 
convalescence  relaxation. 

Arkansas  Hot  Springs. — Light  alkaline-calic  thermal 
springs  used  in  the  treatment  of  syphilis,  gout,  rheuma- 
tism, neuralgia,  and  skin  diseases.  Numerous  fine  hotels 
and  baths. 

Asheville. — Near  the  Blue  Ridge  Mountains,  North  Caro- 
lina, on  a  plateau  of  2,250  feet  elevation.  One  of  the  most 
popular  of  the  southern  health  resorts — utilized  especially 
in  the  treatment  of  pulmonary  tuberculosis  and  diseases  of 
the  lungs.  It  is  also  a  desirable  climate  for  convalescence 
and  rest  after  nervous  strains. 

Atlantic  City. — On  the  Jersey  Coast.  The  best  known 
of  the  northern  coast  resorts.  Abundantly  supplied  with 
fine  hotels  and  sanitoria.  Chief  health  features  are  de- 
rived from  comforts  available  at  the  hotels,  the  baths,  and 
the  boardwalk  near  the  ocean, — broad  and  of  great  length. 
The  climate,  though  somewhat  milder,  is  not  greatly  dif- 
ferent from  neighboring  places.  It  is  of  most  use  medi- 
cally to  convalescents  and  to  those  needing  rest  and  re- 
laxation. 

Bermuda. — A  beautiful  island  36  hours  from  New  York 
by  comfortable  steamer.  Patronized  to  the  greatest  extent 
by  Americans  about  Easter-time.  Delightful  climate  most 
of  the  year,  many  diversions  and  a  restful  atmosphere. 
Chief  towns  are  St.  Georges  and  Hamilton — the  latter 
place  having  two  good  hotels.  Ideal  spot  for  convales- 
cents, nervous  irritability,  cardiac  and  renal  conditions, 
and  for  a  rest  cure.  Best  accommodations  for  invalids 


52  HEALTH  RESORTS 

in  the  Bermuda  Sanitarium  on  Ferry  Reach  in  West  St. 
Georges. 

Colorado  Springs. — Attractive  health  resort  at  the  foot 
of  the  Rocky  Mountains  near  Pike's  Peak,  altitude,  6,000 
feet.  Abundance  of  sunshine,  cool  climate,  low  humidity, 
dry  porous  soil,  beautiful  scenery  and  beautiful  residences, 
with  pleasant  social  life. 

This  climate  is  admirably  suited  to  pulmonary  tubercu- 
losis— especially  the  incipient  forms. 

Eastern  Health  Resorts. — Maine,  Moosehead  and 
Rangely  Lakes.  Cool,  clear  air.  Fine  fishing  and  camp 
life. 

Poland  Springs  and  Rockland — fine  hotels  and  good 
climate. 

Mt.  Desert  and  the  Maine  coast.     Cool  refreshing  climate. 

Frequent  fogs.     Attractive  social  life. 

Florida  Coast  Resorts. — Jacksonville,  St.  Augustine, 
Palm  Beach,  Ormond  and  Tampa.  Well  supplied  with 
magnificent  hotels.  Climate  equable,  temperate,  warm  and 
humid.  Good  for  physical  and  mental  relaxation  but  poor 
for  pulmonary  troubles. 

French  Lick  Springs. — Orange  County,  Indiana.  Sul- 
phated  saline  waters. 

Glenwood  Springs. — Glenwood  Springs,  Colorado.  Alti- 
tude, 5,200  feet.  Fine  accommodations.  Cool,  bracing 
air. 

Hot  saline  sulphur  springs  with  fine  pool  and  baths,  and 
natural  sulphur  vapor  cave. 

Of  value  in  chronic  rheumatism,  gout,  cutaneous  and 
renal  diseases. 

Hawaiian  Islands. — Twenty-one  hundred  miles  south- 
west from  San  Francisco — 6%  days  by  steamer. 

Volcanic  origin.  Beautiful  scenery.  Tropical  vegeta- 
tion. Equable,  comfortable  climate,  occasionally  warm  and 
moist. 

Lakewood. — Ten  miles  inland  from  the  Jersey  Coast. 
Sixty  miles  south  of  New  York — easily  accessible  and  well 
supplied  with  fine  hotels.  In  the  heart  of  the  Jersey  pine 
belt  where  the  soil  is  dry  and  sandy.  Temperature  usually 
10°  warmer  than  New  York. 

Well  deserved  reputation  for  curing  protracted  colds, 
catarrh,  influenza,  and  all  forms  of  convalescence. 

Mt.  Clemens,  Mich. — Strong  saline  springs  with  good  ac- 


HEALTH  RESORTS  53 

commodations.  Useful  in  chronic  rheumatism  with  stiffened 
joints,  and  neuralgia,  scrofulous  disorders  of  skin,  bones  and 
joints. 

Old  Point  Comfort. — North  of  Hampton  Roads,  Va,,  near 
Fortress  Monroe.  Temperature  variation  from  40° 
(Winter)  to  80°  (Summer).  Bathing,  boating  and  attrac- 
tive social  life.  Of  benefit  to  people  suffering  from  catarrh, 
bronchitis  and  nervous  troubles. 

Poland  Springs. — South  Poland,  Maine.  Superb  hotel. 
Mild  alkaline-calic  water,  used  in  treatment  of  rheumatism, 
gout,  dyspepsia,  renal  and  hepatic  disorders. 

Richfield  Springs. — Lake  Canandaigua,  N.  Y.,  altitude 
1,750  ft.  Beautiful  country.  Attractive  hotel  life.  White 
Sulphur  Springs — of  value  in  insomnia  from  overwork, 
nervousness  or  anxiety,  stomach  disorders,  gout,  rheumatism 
and  some  disorders  of  the  liver  and  kidneys. 

Saratoga  Springs. — The  most  famous  watering  place  in 
the  United  States,  with  many  large  hotels.  Most  of  the 
waters  may  be  described  as  muriated  alkaline-calic  car- 
bonated waters.  The  best  known  are  the  Congress,  Geyser, 
Hathorn,  Kissingen,  Seltzer,  United  States,  Vichy,  Carlsbad 
and  Champion  Springs.  As  these  waters  are  quite  potent 
they  should  be  taken  under  medical  supervision. 

They  are  most  used  in  dyspepsia,  engorgement  of  the 
liver  and  portal  system  and  chronic  constipation. 

St.  Lawrence  River. — The  Thousand  Islands  offer  a  de- 
lightful region  for  rest  and  recreation  with  cool,  equable 
medium-moist  climate.  Fine  hotels,  or  rough  camps  are 
available. 

Southern  California. — Coronado. — Attractive  coast  resort 
with  fine  hotel  and  equable  marine  climate. 

Los  Angeles. — Enterprising  city  14  miles  from  the  ocean 
and  also  from  the  mountains.  Mild  climate — many  fogs. 

Monterey.  One  hundred  and  twenty-five  miles  south 
of  San  Francisco  on  the  Pacific  Coast.  Fine  hotel — Del 
Monte — and  beautiful  country-gardens  and  drives.  Climate 
mild,  equable  but  humid. 

Pasadena.  Nine  miles  from  Los  Angeles — altitude  900  ft. 
Twenty  miles  from  the  sea  and  five  from  the  mountains. 
Charming  city  of  attractive  homes  and  fine  hotels.  Rest- 
ful climate. 

Santa  Barbara. — Climate  mild  and  equable — like  the 
Riviera.  Many  foggy  days.  Good  hotel. 


54  HEALTH  RESORTS 

Adapted  for  cases  of  nervous  exhaustion  and  con- 
valescents. 

San  Diego.  One  of  the  most  equable  climates  in  the 
United  States,  with  maximum  number  of  sunny  days,  al- 
though the  humidity  is  not  low.  Nights  are  cool.  Adapted 
to  cases  of  nervous  exhaustion. 

Sierra  Madre. — Twelve  miles  north  of  Los  Angeles.  Alti- 
tude 1,700  ft.  Most  desirable  climate  in  Southern  Califor- 
nia for  consumptives. 

Paso  Robles. — El  Paso  de  Robles,  California.  Altitude 
800  ft.  Climate  mild  and  luxurious,  atmosphere  pure, 
balmy,  and  invigorating,  equable  and  dry.  Hot  springs 
are  sulphurous  and  alkaline.  Good  bathing  accommoda- 
tions. Beneficial  to  sub-acute  and  chronic  rheumatism, 
scrofula,  blood,  glandular  and  cutaneous  affections. 

Redlands.  Elevation  1,350  ft.  at  foot  of  San  Bernardino 
Mountains.  Fertile  country,  climate  warm  but  not  hot, 
and  equable.  Comfortable  for  invalids. 

Riverside.  Elevation  850  ft.  Sixty  miles  east  of  Los 
Angeles,  eight  miles  from  Redlands.  Many  fine  residences 
and  hotels.  Fertile  orange  country.  Comfortably  warm 
and  dry  climate.  Delightful  for  invalids  and  convalescents. 

Strong  Medicine. — In  Large  Doses  for  Those  Whose 
Enthusiasm  is  Failing. 

Yellowstone  National  Park  (Wyoming).  A  museum  of 
nature  containing  geysers,  boiling  springs,  terrace  and 
crater  formations,  cliffs  of  obsidian,  deeply  cleft  canyons, 
petrified  trees,  sulphur  hills  and  pine  forests.  Situated 
on  a  plateau  of  8,000  ft.  elevation  surrounded  on  all  sides 
by  mountains. 

The  Grand  Canyon  of  the  Yellowstone  is  a  magnificent 
canyon  20  miles  long,  600  to  1,200  ft.  deep,  with  walls  of 
gorgeous  colors.  Climate  bracing.  Nights  cold. 

Grand  Canyon  of  the  Colorado  (Arizona.)  One  of  the 
most  stupendous  natural  wonders  of  the  world.  3,000- 
5,000  ft.  deep,  217  miles  long,  10-13  miles  mide.  The 
walls  are  terraced  and  carved  into  a  myriad  of  pin- 
nacles and  towers  and  are  tinted  with  various  brilliant 
colors. 

To  the  south  are  the  cliff  dwellings,  the  petrified  forest 
and  the  land  of  "silence,  sunshine  and  adobe."  Elevation 
of  the  rim  of  the  canyon  about  7,000  ft.  Climate  dry  and 
bracing,  with  cool  nights. 


HEALTH  RESORTS  55 

Yosemite  Valley  (National  Park).  On  the  west  slope 
of  the  Sierra  Nevada  Mountains  in  California.  A  valley 
with  level  floor  8  miles  long  with  enclosing  walls  3,000- 
5,000  ft.  in  height — almost  vertical.  The  chief  features 
are  the  Yosemite  Falls  (2,500  ft),  Bridal  Veil  Fall,  El 
Capitan  peak  (7,042  ft.),  and  Half  or  South  Dome  (8,852 
ft.). 

Niagara  Falls,  New  York.  On  the  Niagara  River. 
One  of  America's  greatest  natural  wonders.  American 
Falls  167  ft.  high,  1,000  ft.  wide.  Canadian  Falls  158  ft. 
high,  2,550  ft.  wide.  Volume  of  water  12  million  cubic  ft. 
a  minute. 

The  Great  Lakes. — "In  all  the  world  no  trip  like  this." 
A  delightful  steamer  trip  of  several  days  on  fine  steamers 
from  Buffalo  via  Mackinaw  to  Duluth  or  Chicago,  through 
Lake  Erie,  the  Detroit  River,  Lake  St.  Clair,  Lake  Huron, 
Lake  Michigan  or  Lake  Superior  through  the  Sault  St. 
Marie.  Pure  bracing  air,  pure  water,  at  times  out  of  sight 
of  land,  at  times  running  close  to  picturesque  and  refresh- 
ing land  scenery. 

Canadian  Rockies. — Banff — 4,520  ft.  elevation.  The  head- 
quarters of  the  Canadian  National  Rocky  Mountain  Park. 
Fine  hotels  here  and  at  Laggan  (5,040  ft.)  Glacier  (4,095 
ft.)  and  Field  (4,064  ft.)— the  last  near  the  famed  Yoho 
Valley.  The  magnificent  mountain  peaks  of  this  region  are 
almost  innumerable — averaging  10,000  to  12,000  ft,  in  height 
and  of  a  rugged  nature.  Ideal  camping  and  fine  hunting, 
with  cool  bracing  air. 

Virginia  Hot  Springs. — Large  modern  hotel  and  elabo- 
rate baths.  Popular  health  resort  in  Spring  and  Fall. 
Alkaline-calic  springs  resembling  those  of  Aix-les-Bains, 
used  in  rheumatism,  gout,  sciatica,  neuralgia,  etc.  Com- 
petent physicians. 

Watkins  Glen  Springs. — Watkins,  N.  Y.  on  Seneca  Lake. 
A  modern,  well-equipped  sanitarium  with  beautiful  sur- 
roundings. Salinic-calic  waters  charged  with  carbonic  acid 
gas  used  in  the  treatment  of  glandular  and  rheumatic 
troubles,  gout,  lumbago,  sciatica  and  chronic  diseases  of 
the  heart.  For  the  last  the  Schott  method  is  employed  as 
at  Nauheim. 

White  Mountains. — The  air  of  the  White  Mountains  is 
cool,  pure  and  clear.  Popular  resorts  are  Bethlehem,  1,459 
ft.,  Jefferson,  1,440  ft.,  Dublin,  1,500  ft.,  Franconia,  1,100 


56  COLD  IN  THE  HEAD 

ft.  and  Bretton  "Woods,  where  is  located  the  magnificent 
Mt.  Washington  hotel. 

Cold  in  the  Head  (Nasal  Catarrh) . — What  is  the  meaning 
of  that  very  common  kind  of  catarrh  called  a  cold  in  the 
head?  It  is  probably  this — that  the  catarrh  (with  all  its 
sneezing,  shivering,  nose-running)  is  an  effort  on  the  part 
of  nature  to  get  rid  of  some  germs  which  we,  in  a  minute 
of  depression  (due,  e.  g.,  to  cold,  fatigue,  or  worry,  or  lack 
of  food),  breathed  into  our  mouth  or  nose  and  allowed  to 
settle  and  breed  there.  Do  what  you  will  with  a  cold  in  the 
head,  you  cannot  "cure"  it,  and  if  you  hasten  nature's 
three  day  process  too  much,  then  the  system  may  fail  to 
throw  off  the  poison,  and  the  cold  "gets  down  into  the 
chest"  as  we  say,  and  we  get,  perhaps,  bronchitis.  The 
present  writer  is  sure  that  all  colds  are  first  local  to  the  nose 
or  throat,  and  that  local  treatment,  aiming  both  at  easing 
the  symptoms  and  encouraging  the  natural  process,  is  most 
likely  to  be  serviceable.  A  cold,  then,  takes  three  days, 
more  or  less,  to  run  its  course,  and  the  sensible  way  of 
dealing  with  it — since  we  cannot  "cure"  it,  is  to  help  it 
along  and  give  the  system  every  chance  of  throwing  it  off. 
This  "throwing-off"  the  poison  is  done  by  the  kidneys, 
lungs  and  skin,  but  chiefly  by  the  two  former,  for  the  skin 's 
nervous  apparatus  has  been  rather  out  of  order  since  the 
"cold  "was  "caught." 

So  the  best  "cure"  is  to  make  the  blood  as  pure  as  we 
can.  As  soon  as  ever  you  know  that  you  have  got  a  cold, 
start  right  away  to  treat  it.  This  is  done  (1)  by  keeping 
indoors  from  the  moment  that  the  cold  is  caught,  in  a  well- 
ventilated  (not  stuffy)  but  warm  room — say  60°-65°  F. — 
by  wrapping  up,  as  long  as  any  feeling  of  chilliness  or  f  ever- 
ishness  lasts ;  and  by  sleeping  a  little  more  warmly  at  night 
than  usual.  (2)  As  you  are  to  rest  and  stay  indoors,  even 
if  not  in  bed,  for  three  days,  you  require  very  little  food, 
and  no  meat  food.  Your  object  is  to  clear  the  blood  of  all 
impurities.  Drinks  of  hot  lemon  water  should  be  taken 
often,  to  wash  out  the  stomach  and  bowels  and  flush  out 
the  kidneys. 

Now  as  to  medicines.  Take  two  grains  of  calomel  fol- 
lowed by  aperient  salts.  Take — frequently  repeated — 
coryza  tablets  containing  aconite  and  belladonna,  and 
douch  out  the  naso-pharyngeal  passages  frequently  with 
dilute  borolyptol,  listerine,  glycothymoline  or  alkalol. 


COLIC  57 

But  your  cold  is,  perhaps,  a  more  serious  infection  than 
you  thought;  you  are  feverish  and  wretched,  and  cough  a 
little.  Have  a  hot  mustard  foot  bath  at  bedtime,  then ;  and 
when  in  bed,  a  basin  of  hot  gruel.  Get  as  much  rest  and 
sleep  as  you  can.  For  the  cough,  take  ipecacuanha  wine, 
10  drops,  and  paregoric,  20  drops,  in  some  water  every 
three  hours  (smaller  doses  for  children). 

On  the  fourth  day,  if  much  better,  you  may  go  out,  if 
warmly  wrapped;  don't  overweight  yourself  with  clothes, 
however.  Then  begin  a  tonic  medicine — quinine  and  iron 
mixture  twice  a  day.  (See  also  "Cough"  and  "Sore 
Throat") 

Cold-on-the-Lip. — This  is  a  little  skin  eruption  which  oc- 
curs on  the  lips,  or  in  the  nostrils  sometimes,  when  one 
has  a  "cold  in  the  head."  Its  proper  name  is  herpes, 
and  it  is  described  under  that  heading.  The  same  eruption 
is  apt  to  occur  on  the  private  parts,  and  in  some  people, 
round  the  waist,  where  it  is  called  shingles.  (See 
"Herpes.")  It  is  contagious  to  some  extent  and  may  be 
communicated  by  kissing.  It  is  not  dangerous. 

Once  formed  these  herpetic  vessels  are  very  difficult 
to  control,  but  they  may  sometimes  be  aborted,  in  the  earliest 
stages,  by  peroxide  of  hydrogen  and  camphor  cream  locally, 
in  connection  with  a  calomel  cathartic. 

Colic. — A  violent  sudden  pain  in  the  abdomen. 

(1)  Flatulent  colic  is  often  very  sudden  and  very  pain- 
ful, but  it  is  caused  by  nothing  more  serious  than  "gas" 
in  the  bowels,  which  makes  them  swell  out,  and  which  is 
caused  by  decomposition  of  food,  the  indigestion  being  due 
to  something  wrong  with  the  bile  or  other  of  the  digestive 
juices.     Such  colic  is  especially  common  in  weak  and  in 
hysterical  people,  also  in  artificially-fed  infants. 

(2)  Wind  colic  in  small  infants  must,  of  course,  be  treated 
by  attending  to  the  feeding,  and  to  more  cleanliness  in  the 
bottles  and  teats  used.     This  griping  in  children  is  some- 
times cured  by  a  smart  purge    (say  two  teaspoonfuls  of 
castor  oil)  ;  but  when  a  child  is  continually  having  griping 
attacks  (as  shown  by  it  making  grimaces  and  drawing  up 
its  legs),  there  can  be  no  doubt  that  the  food  disagrees  with 
it.     Oil  of  anise,  one  or  two  drops  on  a  small  lump  of 
sugar,  may  be  given  every  hour  and  Dill  water  is  a  favorite 
remedy  in  teaspoonful  doses  every  hour.     In  adults  the 
colic  is  generally  due  to  some  irritating  article  of  food  which 


58  CONCUSSION  OF  THE  BEAIN 

may  be  purged  out  with  an  ounce  of  castor  oil.     A  hot- 
water  bottle  applied  to  the  belly  gives  much  relief. 

(2)  Lead  colic.     (See  "Lead-Poisoning.") 

(3)  Renal  colic.     (See  "Stone  in  the  Kidney.") 
(2)  Liver  colic  (See  "Gall- Stones.") 

(4)  Liver  colic.     (See  "Gallstones.") 

(6)  Intussusception  or  telescoping  of  the  gut. 

(5)  Volvulus,  or  twisting  of  the  gut. 

The  last  two  are  rare.  Intussusception  of  the  gut  is 
similar  to  what  takes  place  in  the  fingers  of  a  tightly-fitting 
glove  as  they  are  turned  outside  in  when  the  glove  is  drawn 
off  a  warm  hand.  The  intense  pain,  bowel  obstruction,  pas- 
sage of  blood  from  the  rectum  and  collapse  of  the  patient 
show  what  has  happened  and  very  soon  there  is  a  big 
tumor  to  be  felt  in  the  belly  and  the  patient  begins  to 
v omit  the  contents  of  the  bowels.  Nearly  all  the  cases  are 
in  children  who  have  been  too  severely  purged.  It  is  use- 
less for  a  layman  to  attempt  to  treat  that. 

Collapse. — By  this  word  is  meant  the  state  of  utter  pros- 
tration which  may  follow  a  serious  accident,  a  great  loss 
of  blood,  an  acute  fever,  or  a  blow  in  the  pit  of  the  stomach. 
Very  great  grief  may  have  a  similar  effect.  In  all  cases 
of  collapse  or  shock,  keep  the  sufferer  warm,  elevate  the 
extremities,  loosen  the  collar  and  all  constricting  bands 
and  stimulate  with  sal  volatile,  smelling  salts,  aromatic 
spirits  of  ammonia,  whisky  or  brandy. 

Coma. — By  this  term  is  meant  insensibility,  unconscious- 
ness, in  which  the  patient  cannot  be  roused,  and  touching 
the  naked  eyeball  with  the  finger  tip  produces  no  effect. 
The  breathing  is  deep  and  slow  and  noisy.  The  chief  causes 
of  coma  are  apoplexy  (which  see)  and  diabetes  (which  see). 
Sometimes  the  comatose  person  dies  without  regaining  con- 
sciousness; sometimes  he  recovers.  In  diabetic  coma,  how- 
ever, his  chances  of  recovery  are  very  small. 

Concussion  of  the  Brain  (Stun). — A  blow  on  the  head  or 
a  fall  may  so  shake  up  the  brain  as  to  cause  the  patient 
to  be  stunned.  This  is  shown  by  pallor  of  face,  and  a 
state  of  faintness  and  unconsciousness,  which  may  last 
only  for  a  few  minutes,  or  may  continue  for  hours.  Re- 
covery may  soon  occur  with  vomiting,  if  there  be  no  severe 
internal  injury  to  the  head,  but  if  the  concussion  has  led 
to  bleeding  in  or  upon  the  brain  great  danger  to  life  will 


CONSUMPTION  59 

ensue.  Put  patient  in  bed  and  keep  head  high  and  send 
for  doctor. 

Confinement. — To  calculate  when  a  baby  will  be  born, 
take  the  date  of  the  last  day  of  the  last  menstruation,  add 
seven  days  and  go  back  three  months.  For  instance,  if 
the  last  day  of  the  last  menstrual  period  was  January  7th, 
add  seven  days — January  14th,  and  go  back  three  months, 
to  October  14th,  which  will  be  the  date  of  the  birth  of  the 
child. 

Constipation. —  (See  ''Costive  Bowels.") 

Consumption. — This  disease  causes  more  deaths  in  this 
country  than  any  other  form  of  illness.  In  infancy  it  at- 
tacks the  brain,  in  childhood  chiefly  the  bowels,  and  in  early 
manhood  the  lungs  suffer  most  often.  In  former  days  the 
disease  used  to  be  called  a  decline.  To  be  "in  a  decline" 
meant  that  the  lungs  were  diseased,  and  that  an  early  death 
by  gradual  wasting  was  possible. 

Until  quite  recently  consumption,  the  medical  name  for 
which  is  phthisis,  was  considered  to  be  essentially  an  in- 
herited disease;  but  of  late  years  medical  opinion  has 
changed,  and  all  doctors  now  consider  that  phthisis  is 
capable  of  being  caught  by  infection,  which  arises  from 
germs  breathed  in  from  the  air  having  escaped  from  con- 
sumptive lungs,  or  from  those  contained  in  tubercular  milk 
and  tubercular  meat. 

To-day  we  do  not  believe  in  the  inheritance  of  consump- 
tion from  parents.  Each  case  of  consumption  is  viewed  as 
a  case  of  infection  by  the  germ  of  the  disease.  What  may 
be  inherited,  is  a  weakly  state  of  body,  favoring  infection. 

The  alteration  in  modern  medical  opinion  has  been  due 
to  the  great  improvement  effected  in  microscopes  in  recent 
years,  by  which  it  has  been  possible  to  discover  the  pres- 
ence of  extremely  minute  organisms,  called  bacteria  or 
bacilli,  in  the  phlegm  coughed  up  by  consumptives,  and  even 
in  their  saliva,  their  urine,  and  blood.  By  experiments  on 
animals  it  has  been  shown  that  inoculation  with  these  bacilli 
will  cause  the  disease  to  break  out  in  them. 

These  bacilli,  however  they  may  enter  the  human  body, 
whether  in  our  food,  or  in  milk,  or  by  being  inhaled  in  the 
air  we  breathe,  will  set  up  the  state  of  disease  now  called 
tuberculosis;  and  the  part  first  attacked,  although  most 
often  the  lungs,  may  be  the  bowels,  kidneys,  or  skin. 

II. — Cattle  also  may  die  naturally  from  tuberculous  dis- 


60  CONSUMPTION 

eases  set  up  by  infection  with  bacilli,  and  it  is  an  accepted 
opinion  that  children  may  get  infected  from  milk  taken 
from  cows  already  diseased.  Even  grown-up  persons  may 
become  infected  with  tuberculosis  by  eating  the  meat  ob- 
tained from  diseased  cows.  It  is  for  this  reason  that  so 
much  attention  is  now  given  to  the  examination  of 
slaughtered  animals  in  butchers'  shops. 

Cattle  are  certainly  liable  to  tuberculosis  of  the  internal 
organs,  and  may  die  of  it.  The  slaughter  houses  of  our 
cities  are  now  under  inspection,  so  that  diseased  meat  may 
be  discovered  and  destroyed;  but  until  recently  the  Jews 
alone  were  particular  about  refusing  the  meat  of  diseased 
cows,  and  it  is  certain  that  the  Jews  have  always  had  a 
lower  death  rate  from  consumption  than  Christians.  With 
the  Jews  it  is  a  matter  of  religion  to  have  their  butchers' 
meat  passed  by  a  Hebrew  official,  and  it  is  then  marked 
as  Kosher. 

The  principal  contagion  from  consumption  of  the  lungs 
is  found  in  the  phlegm  coughed  up  and  expectorated.  In 
this  phlegm  the  bacilli  are  to  be  found  in  millions.  When 
the  phlegm  dries  up  and  is  powdered  under  foot,  the  wind 
blows  the  germs  about,  and  women's  long  skirts  spread 
them  from  room  to  room.  This  dust  is  inhaled,  and  falls 
into  our  drink  and  food,  and  so  the  disease  is  spread. 

If  there  is  one  point  more  important  than  all  others,  it 
is  that  all  consumptives  should  spit  into  basins  or  bottles 
containing  antiseptic  liquids,  or  else  into  paper  handker- 
chiefs, which  can  be  burned.  These  are  now  procurable 
very  cheaply. 

Consumptive  patients,  although  they  feel  great  debility, 
have  a  bad  digestion,  frequent  cough,  and  often  suffer 
from  diarrhea  and  night  sweats,  yet  they  are  generally 
of  a  hopeful  turn  of  mind.  They  grow  gradually  weaker 
and  thinner  month  after  month,  and  yet  are  always  look- 
ing forward  to  a  recovery,  which  is  unlikely. 

III. — In  cases  of  consumption  or  tuberculous  disease  of 
the  lungs,  it  is  usual  to  find  one  lung  affected  before  the 
other,  or  one  lung  much  more  affected  than  the  other ;  and 
the  upper  lobes,  under  the  collar  bone  are  generally  the 
first  to  suffer.  The  disease  at  first  causes  patches  of  con- 
solidation, which  may  either  dry  up  and  become  chalky 
nodules,  or  else,  if  the  general  health  be  bad,  the  patches 
soften  down,  and  abscesses  form.  The  lung  structure  gets 


CHRONIC  CONSUMPTION  61 

eaten  out  into  holes  by  ulceration;  these  are  called  cavi- 
ties, and  matter,  with  phlegm,  collects  in  them,  especially 
at  night ;  hence  it  is  that  consumptives  so  often  have  a  severe 
cough  in  the  morning,  the  cough  being  for  the  purpose  of 
getting  rid  of  the  accumulation.  Phthisis  is  not  usually  a 
painful  disease,  the  only  pain  in  the  chest  being  usually 
due  to  attacks  of  pleurisy  in  the  dry  stage.  Much  dis- 
comfort is,  however,  often  felt  from  the  disordered,  shallow, 
and  rapid  breathing. 

Yty. — ' '  GALLOPING  CONSUMPTION.  ' ' — Although  consump- 
tion is  most  common  in  its  chronic  form  there  is  an  acute 
variety,  most  commonly  seen  in  young  adults,  in  which  the 
first  symptoms  are  fever,  shortness  of  breath,  and  weakness, 
and  these  lead  on  to  death  in  a  few  weeks.  In  such  cases  the 
lungs  are  found  after  death  studded  with  numerous  quite 
small  points  of  disease,  which  have  abolished  the  use  of 
the  lungs  for  breathing  purposes,  and  death  is  from  the 
impurity  of  the  blood. 

V. — "CHRONIC  CONSUMPTION." — Chronic  phthisis  or 
tuberculous  consumption  of  the  lungs  seldom  causes  death 
the  first  year,  and  it  may  last  for  many  years,  and  even 
after  a  long  course  there  may  be  an  almost  complete  re- 
covery. This  slow  recovery  is  more  common  of  late  years 
than  formerly;  this  good  result  is  from  the  modern  plan 
of  open-air  treatment  and  good  feeding. 

The  ordinary  consumptive  patient  is  a  pale,  round- 
shouldered,  thin  person,  with  a  chronic  cough,  who  suffers 
from  loss  of  appetite,  indigestion,  and  occasional  diarrhea; 
his  heart  is  feeble,  and  he  is  short  of  breath,  and  is  liable 
to  night  sweats. 

A  long  continuing  cough,  spitting  of  a  little  blood,  and 
a  very  slow  gradual  loss  of  weight  and  fat,  with  weakness 
are  the  most  frequent  signs  of  the  onset  of  consumption, 
and  should  always  alarm  a  patient's  friends,  and  this  occurs 
before  any  notable  lung  diseases  can  be  found  by  examina- 
tion. As  the  beginning  of  the  disease  is  so  faintly  marked, 
there  being  no  violent  or  urgent  symptoms,  it  very  often 
happens  that  the  ailment  is  well  established  before  any 
curative  measures  have  been  undertaken.  This  is  a  great 
misfortune,  because  consumption  of  the  lungs  is  especially 
a  disease  which  is  curable  at  the  beginning  but  incurable 
when  the  structure  of  the  lung  has  been  destroyed,  and 
the  lung  is  full  of  cavities. 


62         TREATMENT  OF  CONSUMPTION 

The  diagnosis  of  the  disease,  although  still  imperfect,  is 
much  more  easy  than  in  olden  times ;  the  modern  physician 
examines  the  chest  by  observing  its  state  of  expansion  by 
the  breathing;  he  feels  its  expansion  with  the  hands;  by 
tapping  the  chest  all  over  he  discovers  any  loss  of  the  natural 
elasticity,  and  by  the  use  of  the  stethoscope  he  hears  the 
sounds  made  by  the  air  entering  and  leaving  the  lungs, 
and  can  discover  whether  the  air  tubes  are  too  dry, 
or  if  they  contain  liquids,  such  as  phlegm,  blood  or  mat- 
ter; and  can  discover  whether  or  not  the  lung  is  already 
eaten  out  into  hollow  places,  called  cavities. 

Cases  of  serious  lung  disease  vary  widely  as  to  symp- 
toms, and  especially  as  to  the  presence  or  absence  of  bleed- 
ing. The  coughing  up  of  blood  is  a  very  alarming  symp- 
tom, and  one  which  in  rare  cases  may  cause  sudden  death 
from  fainting  or  suffocation.  In  most  patients,  however, 
blood-spitting,  or  haemoptysis,  is  only  slight,  but  it  may  be 
frequent.  When  it  occurs  quite  early  in  the  case,  and  is 
only  trifling  in  amount,  it  does  no  harm,  and,  indeed,  serves 
the  useful  purpose  of  calling  attention  to  the  nature  of 
the  illness,  and  it  leads  to  prompt  and  serious  treatment 
of  the  patient.  When  it  is  profuse,  it  causes  weakness,  for 
a  consumptive  patient  cannot  afford  to  lose  blood,  and  is 
generally  already  pale,  and  his  blood  of  poor  quality. 
Haemoptysis  is  a  serious  matter  when  it  occurs  from  the 
rupture  of  a  large  blood  vessel  in  a  cavity  in  the  lung,  and 
immediate  medical  aid  must  be  summoned,  and  until  a 
doctor  arrives  the  patient  must  be  put  to  bed,  with  head  and 
shoulders  raised,  and  must  be  cautioned  not  to  talk  or  use 
any  exertion.  Ice  may  be  given  him  to  suck  in  small  quan- 
tities. 

VI. — Treatment  of  Consumption.  (1) — The  treatment 
consists  of  every  effort  to  improve  the  general  health  of 
the  patient  by  sanitary  methods,  by  good  feeding,  by  open- 
air  life,  and  gentle  exercises,  and  by  the  treatment  and 
cure  of  all  painful  and  exhausting  symptoms  as  soon  as 
they  arise. 

It  must  be  admitted  that  although  science  has  been  at 
the  work  of  searching  for  an  antidote  to  the  poison  of 
tuberculosis  for  hundreds  of  years,  the  constant  result  has 
been  failure. 

Mercury,  iodine,  and  arsenic  have  each  had  a  short  repu- 
tation as  a  cure  for  phthisis;  and  so  have  creosote,  car- 


TREATMENT  OF  CONSUMPTION         63 

bolic  acid,  guaiacol,  and  sulphur.  Dozens  of  substances 
have  been  tried  as  vapors  and  inhalations  in  hopes  of  kill- 
ing the  germs  in  the  air  tubes  of  the  lungs,  such  as  turpen- 
tine, terebene,  eucalyptus  oil,  prussic  acid,  iodine,  naphtha, 
tar  vapor,  and  oxygen  gas ;  but  they  have  all  failed  to  check 
the  disease.  Then,  again,  local  applications  to  the  chest 
have  often  been  vaunted  as  cures,  such  as  applications  of 
iodine  liniment,  and  turpentine,  mustard  plasters,  and 
blisters  of  cantharides ;  also  the  use  of  issues  and  of  cup- 
ping. 

There  are  many  clever  physicians  in  different  parts  of 
the  world  at  work  on  the  treatment  of  consumption  by  vac- 
cines and  serum.  Marmorek,  F.  von  Behring,  Wright, 
Trudeau  and  others,  are  those  to  whom  we  look  for  further 
knowledge  on  this  subject,  but  though  they  are  all  success- 
ful in  some  of  the  cases,  they  do  not  succeed  often  enough 
to  enable  them  to  pin  their  faith  to  any  one  method.  There 
is  no  doubt,  however,  that  the  use  of  some  vaccines  in  the 
form  of  certain  tuberculins  is  of  appreciable  assistance 
to  the  other  methods  of  treatment  in  the  early  cases  of  con- 
sumption with  slight  involvement  of  the  lung. 

VII. — Treatment  of  consumption.  (2) — After  mention- 
ing so  many  medicines  which  do  so  little  good  to  persons 
who  are  suffering  from  phthisis,  or  tuberculous  consump- 
tion of  the  lungs,  we  may  fitly  advise  as  to  the  treatment 
which  may  be  expected  to  lengthen  life,  and  so  give  nature 
a  chance  to  cure  the  disease,  for  that  seems  the  utmost  which 
present  knowledge  can  do. 

Reliance  must  be  placed  more  on  general  principles  than 
upon  drugs,  and  most  important  are  the  open-air  life, 
plenty  of  good  food,  and  the  addition  of  the  preparations 
of  cod-liver  oil  and  malt.  It  is  of  great  importance,  on 
the  other  hand,  to  avoid  unhealthy,  close  bedrooms,  gas- 
lit  workshops,  and  the  too  close  associations  with  other  per- 
sons. Cases  of  consumption,  early  taken  to  fresh  air 
sanatoria  and  there  treated,  almost  invariably  recover. 
The  main  point  is  to  detect  the  disease  in  its  early  stages. 

The  utmost  importance  must  be  given  to  rules  to  avoid 
self-contagion,  by  cleanliness,  changes  of  clothing  and  bed- 
linen  ;  and  remember  that  these  patients  must  never  swallow 
the  phlegm  they  cough  up,  but  must  use  a  pocket  spittoon 
or  a  paper  handkerchief,  which  can  be  burnt. 

The  most  certain  way  for  a  consumptive  to  infect  other 


64         TREATMENT  OF  CONSUMPTION 

people  is  to  cough  or  sneeze  without  protecting  the  mouth 
with  a  piece  of  cloth.  As  a  result  of  the  coughing  the 
saliva  is  expelled  in  a  fine  spray  which  may  float  about  in 
the  air  and  be  inhaled  by  someone  else  at  a  distance  of 
several  feet. 

The  next  most  certain  way  for  a  consumptive  to  infect 
other  people  is  to  spit  on  the  floor  anywhere  around  him; 
and  the  reason  is  that  when  the  phlegm  dries  it  becomes 
ground  into  the  dust  by  the  feet,  and  the  dust  floats  up  into 
the  air  which  others  breathe,  gets  into  the  air  tubes  of  their 
lungs,  and  thus  starts  the  disease  in  a  new  place. 

The  consumptive  needs  to  be  treated  as  an  invalid, 
and  should  be  made  to  take  regulated  exercise  and 
regular  rest,  and  regular  meals.  The  appetite  may  be  en- 
couraged by  mixtures  containing  vegetable  and  acid  tonics, 
and  the  digestion  may  be  assisted  by  doses  of  pepsin,  and 
pancreatin,  or  by  food  partly  digested  by  chemical  proc- 
esses. 

Much  milk  and  milk  foods  are  necessary,  and  well- 
cooked  dishes,  but  the  cookery  is  better  plain  and  good  than 
of  the  fancy  sort;  avoid  giving  shellfish,  pastries,  cheese 
and  vinegar ;  but  give  more  than  usual  of  fresh  fruits,  dried 
fruits,  jellies,  fresh  fish  and  fresh,  boiled  vegetables.  Dried 
fish,  bacon,  ham,  and  tinned  foods  are  less  digestible,  and 
are  unsafe.  Emulsion  of  cod-liver  or  olive  oil,  or  sardines 
with  oil,  are  all  valuable,  and  so  are  malt  extract,  maltine, 
meat  extract,  preparations  of  blood  and  bone  marrow. 
Sedative  medicines  are  needed  for  the  cough,  with  astringent 
mixtures  for  diarrhea,  also  special  drugs  to  check  night 
sweats  and  losses  of  blood. 

Night  sweats  are  a  serious  symptom,  which  must  be 
checked  by  medicines,  as  far  as  possible,  because  they  cause 
great  prostration,  and  are  also  a  source  of  danger  by  caus- 
ing the  sufferer  to  lie  in  wet  linen,  in  which  state  he  may 
fall  asleep  and  lie  uncovered,  and  so  catch  fresh  cold.  In 
these  cases  patients  should  wear  flannel  clothing  and  lie  be- 
tween blankets. 

Diarrhea  of  a  particularly  intractable  sort  often  occurs 
in  the  latest  stage  of  consumption,  and  may  resist  all  medi- 
cines. It  is  believed  to  be  due  to  ulcerated  spots  within 
the  bowels.  The  aromatic  confection  powder  is  often  use- 
ful, given  with  paregoric,  or  chalk  and  opium  mixture.  In 


TREATMENT  OF  CONSUMPTION          65 

severe  cases  doctors  may  give  dilute  sulphuric  acid  and 
opium;  or  10  grains  of  camphoric  acid  thrice  daily. 

The  cough  of  consumptives  varies  very  much  in  charac- 
ter. If  dry  and  barking,  it  may  be  due  to  pleurisy ;  a  very 
frequent  cough  is  often  due  to  slight  attacks  of  congestion 
of  the  lungs.  A  continuous  cough,  with  profuse  expectora- 
tion, is  a  sign  that  patches  of  the  lungs  are  softening  and 
breaking  down  into  cavities.  A  cough  with  clear,  frothy 
phlegm  shows  the  occurrence  of  a  little  passing  attack  of 
bronchitis. 

We  append  a  few  "recipes"  which  may  be  useful — al- 
ways remembering  that  doctoring  without  a  doctor  is  not 
without  risk. 

VIII. — Treatment  of  Consumption.     (3)  — 

(a)  For    daily    fever    and    night    sweats. — Quinine 
4              hydrochlorate,  30  grains;  calcium  hypophosphite, 

64  grains;  tincture  of  nux  vomica,  160  minims; 
tincture  of  orange,  1  fluid  ounce;  glycerin,  two 
ounces;  water,  to  eight  ounces.  Take  one  table- 
spoonful  of  this  mixture  half  an  hour  before 
meals  thrice  daily. 

(b)  For  night  sweats. — Atropine  sulphate — gr.  1/100 
taken  at  bedtime. 

(c)  For  a  cough  of  irritation,  without  much  phlegm 
— a  dry  hard  cough. — Codeine,  2  grains;  syrup 
of    orange   flowers,    1    ounce;    distilled   water,    1 
ounce.     Take  a  teaspoonful  occasionally,  holding 
it  in  the  mouth  a  minute  before  swallowing. 

(d)  For  a  cough  with  much  phlegm. — Pure  creosote, 
%  drachm ;  spirit  of  cinnamon,  4  drachms ;  tincture 
of  orange,  2  ounces;  glycerin,  to  4  ounces.     Take 
a  teaspoonful  in  a  wineglassful  of  water  three 
times  a  day. 

(e)  Vomiting — Take  a  hot  drink  of  milk  and  a  tea- 
spoonful  of  brandy  half  an  hour  before  meals ;  and 
5  grains  of  pepsin,  and  a  few  drops  of  lemon  juice 
after  the  meal. 

(f)  Loss  of  appetite  tonic. — Tincture  of  nux  vomica, 
5   minims;   sodium   bicarbonate,   5   grains;   spirit 
of  chloroform,   20  minims;  infusion  of  calumba, 
1  ounce.     Take  this  dose  an  hour  before  each  meal. 


66  CORPULENCE 

(g)  Diarrhea — (1)  If  without  pain — castor  oil,  1 
teaspoonful;  hot  milk,  2  tablespoonfuls ;  brandy, 
1  teaspoonful.  Take  this  draught  first  thing  in 
morning.  (2)  If  with  much  "wind"  in  stomach 
—Liquor  calcis  saccharatus,  1  drachm.  Thrice 
daily.  (3)  If  with  pain — Give  an  enema  into 
the  rectum  of  10  drops  of  laudanum  and  five  grains 
of  tannin  in  2  ounces  of  mucilage  of  starch,  twice 
a  day. 

Corns  and  Bunions. — Nothing  much  can  be  written  about 
corns  or  bunions  that  will  be  of  real  service.  They  are 
thickenings  of  the  skin  caused  by  pressure  or  irritation  of 
badly-fitting  boots.  When  the  bones  of  the  toe  and  the 
joint  also  become  involved  we  call  the  trouble  a  bunion. 
The  first  requisite  is  a  well-fitting  pair  of  boots,  roomy 
enough,  and  straight  along  the  inner  side.  Hard  corns 
ought  to  be  shelled  out  neatly  by  a  competent  chiropodist. 
Amateur  chiropody  is  generally  foolishness.  A  soft  corn, 
which  is  one  that  has  become  sodden  and  soft  through  neg- 
lect and  perspiration,  needs  ordinary  cleanly  surgical  treat- 
ment. If  a  bunion  is  forming,  a  boot  made  with  a  toe  post 
inside  should  be  worn;  but  later  on  nothing  but  a  little 
operation  on  the  joint  will  be  of  any  use.  A  great  many 
corns  have  a  tiny  drop  of  pus  right  in  the  inside  of  them, 
and  that  causes  an  irritation  which  makes  the  skin  hard 
over  them.  A  good  chiropodist  will  know  how  to  deal  with 
it.  Of  course,  there  are  corn  solvents,  which  aim  at  soft- 
ening the  skin  so  that  you  can  peel  it  off;  and  there  are 
corn  plasters  which  relieve  the  pressure  of  the  badly-fitting 
boots.  But  the  really  sensible  way  to  deal  with  a  corn  is 
to  have  it  removed  by  a  chiropodist,  and  to  wear  more  suit- 
able broad-toed  boots  in  future.  Solvents  (so-called)  are 
of  little  use  in  bad  cases. 

Corpulence  or  Obesity  (Too  FAT). — Obesity  is  very 
greatly  a  question  of  heredity  and  no  amount  of  dieting 
will  make  a  difference  to  some  people.  It  may  be  said 
that  when  proper  dieting  cannot  reduce  corpulency,  along 
with  exercise  and  attention  to  skin  and  bowels,  no  drugs  can 
possibly  influence  this  condition  of  body. 

There  are  a  few  well-recognized  causes  of  being  too  fat. 
One  is  over-indulgence  in  alcohol,  another  is  a  too  indulgent, 
selfish  and  luxurious  life,  and  another  is  a  too  sedentary 


CORPULENCE  67 

life.  Women  very  often  get  very  fat  at  the  time  of  the 
change  of  life  (see  " Change  of  Life.").  Idiots  are  very 
often  too  fat,  and  so  are  many  anaemic  girls. 

With  regard  to  dieting,  there  are  two  main  causes  of  get- 
ting obese — the  eating  of  too  much  fat-forming  food,  and 
the  inability  of  the  body  to  deal  with  the  food  properly. 
Of  course,  these  two  causes  may  act  together.  A  person 
who  is  too  fat  may  be  eating  too  much  every  day,  and  may 
also  be  too  feeble  to  make  use  of  the  food  he  eats,  so  that 
it  gets  stored  up  in  his  body  as  fat,  and  he  has  to  carry  it 
about  with  him.  Speaking  generally,  to  begin  to  get  too 
fat  is  to  begin  to  grow  old,  and  that  is  why  people  should 
and  do  avoid  it.  That  is  why  the  old  gentleman  who  has 
left  business  takes  to  gardening,  to  keep  down  his  fat; 
and  why  the  middle-aged  maiden  lady,  with  a  small  cozy 
income  used  to  go  bicycling  for  exercise.  If  you  are  too 
fat  and  want  to  reduce  it,  first  consult  a  doctor.  Let  him 
examine  your  heart,  liver  and  lungs,  because  they  may  be 
hampered  by  the  fat,  and  any  sudden  exercise  may  cause 
faintness  and  even  death,  if  the  heart  be  fatty.  If  there 
is  no  serious  mischief  yet  in  any  organ,  you  may  prepare 
to  take  down  the  fat.  There  are  four  ordinary  ways  of 
doing  this: — (1)  To  "do  Banting,"  i.  e.,  to  go  without 
all  fats,  sugars  and  starchy  foods,  and  eat  only  lean 
meat  and  green  vegetables  (see  "Banting")  ;  (2)  To  eat 
less  sugars  or  starchy  food  such  as  puddings,  bread,  etc. ; 
(3)  To  drink  almost  no  liquids  with  meals  and  none  at  all 
between  meals;  (4)  The  most  complete  and  thorough 
method  is  that  of  Oertel.  It  consists  in  (a)  climbing  hills 
for  hours  every  day ;  ( b )  meals  in  small  quantities,  at  long 
intervals;  (c)  only  one  or  one-and-a-half  pints  of  fluid  is 
allowed  to  be  drunk  in  every  twenty-four  hours.  Of  course, 
all  these  plans  require  a  little  effort  of  will,  and  perse- 
verance, and  so  many  fat  people  are  also  lazy  that  they 
seldom  can  get  up  enough  energy  to  carry  out  any  plan 
thoroughly.  An  excellent  plan  is  to  eat  every  day  only  one 
pound  of  raw,  or  nearly  raw,  gravy  beef,  minced  up,  and 
divided  into  four  meals,  accompanied  by  the  drinking  of 
as  much  very  hot  water  as  possible  (see  "Salisbury  Treat- 
ment"). 

Note  that  certain  persons  are  by  habit  of  body  and  in- 
heritance inclined  to  develop  undue  stoutness.  In  such 
cases  it  is  dangerous  to  attempt  to  reduce  body  weight  be- 


68  COSTIVE  BOWELS 

yond  a  certain  point.  Interference  with  the  natural  bodily 
constitution  always  results  in  disaster,  and  therefore  the 
family  history  must  be  taken  into  account  in  all  cases  of 
treatment  of  obesity. 

Diet  for  persons  who  are  too  fat. — FORBIDDEN. — All  fat 
and  fatty  meats  such  as  goose,  duck,  pork.  All  fatty  fish, 
salmon  and  eels.  All  light  farinaceous  puddings.  Po- 
tatoes, peas,  beans,  and  such  vegetables.  Butter,  cream. 
All  sweet  jams;  sugar  with  fruit  or  tea.  It  is  starchy  and 
sugary  foods  which  tend  to  make  fat. 

ALLOWED. — Lean  meat  and  lean  poultry  in  strict  modera- 
tion. Lean  ham  and  tongue.  Fish  without  rich  sauces, 
and  with  lemon  or  vinegar.  Green  vegetables,  cress,  let- 
tuce, French  beans,  etc.  Fresh  fruit  in  small  quantity. 
Dry  oaten  biscuits  and  gluten  bread.  A  tablespoonful  of 
good  whisky,  in  water,  after  lunch.  Tea  or  black  coffee 
without  sugar,  at  breakfast  or  tea-time. 

Costive  Bowels. — An  enormous  number  of  people  suffer 
from  costiveness  or  CONSTIPATION ;  and  it  is  quite  com- 
mon to  find  people  taking  medicines  that  other  people  have 
told  them  are  "good  for  costiveness,"  instead  of  trying  to 
find  out  what  their  own  costiveness  is  caused  by,  and  seek- 
ing to  remedy  that  particular  cause.  We  shall  say  nothing 
here  about  the  costiveness  which  is  merely  a  symptom  of 
some  disease,  such  as  fever,  anaemia,  Bright 's  disease,  and 
so  on.  The  commonest  causes  of  constipation  in  otherwise 
healthy  people  are : — 

1.  Sedentary  habits,  so  that  the  muscles  of  the  bowels 

are  lax  and  weak,  like  all  the  other  muscles. 

2.  Unsuitable  diet  and  habits  of  eating. 

3.  Nervousness,  because  of  pain  in  the  back  passage, 

due  to  piles,  or  ulcers,  etc. 

4.  Something  wrong  with  the  liver,  so  that  there  is  not 

enough  bile  secreted,  though  there  may  be  too 
much  in  the  blood,  causing  jaundice. 
5.  Occupations  which  cause  continual  free  perspira- 
tion ;  and  diseases  like  diabetes.  In  such  cases  the 
bowels  are  costive  because  there  is  not  enough 
water  left  in  them. 

(1) — Women  are  generally  more  sedentary  than  men, 
especially  milliners  and  shop  girls;  but  men  clerks  and 
those  confined  to  the  house  also  are  very  apt  to  be  costive. 


COUGH  69 

Young  women  too  often  have  a  false  delicacy  in  these 
matters,  which  leads  them  to  postpone  relief  of  the  bowels. 
All  such  sedentary  persons  should  make  a  habit  of  attempt- 
ing relief  of  the  bowels  at  a  fixed  hour  every  day,  until 
success  is  attained.  This  rule  is  much  more  important  than 
it  appears  at  first  sight. 

Secondly,  regular  bodily  exercise  must  be  taken.  Time 
must  be  found  for  it  somehow.  Walking  is  best. 

Thirdly,  a  laxative  should  be  taken  regularly  for  a  time 
until  the  habit  has  become  "second  nature"  to  the  bowels. 
A  purge  is  too  strong;  a  laxative  such  as  one  of  these  is 
best : — 

Cascara  pill,  Triplex  pill,  aloe  belladonna  and  strych- 
nine pill,  Lady  Webster  pill,  compound  licorice  powder,  Sal 
Hepatica,  Hunyadi  Janos,  apenta  water,  sodium  phosphate, 
or  citrate  of  magnesia. 

(2) — As  to  diet  in  costiveness  or  constipation,  many 
people  eat  too  much  meat,  and  many  others  take  too  little 
fluid.  An  excellent  plan  is  to  take  half-a-pint  or  more  of 
pure  cold  water  before  breakfast  and  again  before  going 
to  bed ;  or  else  to  drink  a  free  draught  of  water  after  every 
meal.  Some  prefer  to  drink  hot  water.  The  following 
foods  are  liable  to  cause  constipation : — Eggs,  milk,  tapioca, 
sago,  rice.  And  these  are  "good  for  constipation": — 
Green  vegetables,  stewed  fruits,  wholemeal  brrad,  maize, 
prunes,  Turkey  figs,  honey,  treacle,  gingerbread  (excel- 
lent), Spanish  onions.  The  bad  habits  of  eating  are,  to  eat 
too  fast,  to  bolt  the  food  without  chewing  it,  to  drink  too 
much  alcohol,  to  drink  tea  with  meat  foods. 

(3) — Nervous  people  with  piles  or  fistula  dread  a  motion 
of  the  bowels.  They  should  use  a  glycerin  suppository 
every  other  day,  and  apply  cocaine  and  bismuth  ointment 
locally. 

(4) — Liverishness  is  generally  accompanied  by  costive 
bowels.  Regular  exercise  must  be  taken  and  a  blue  pill  to 
affect  the  liver,  may  be  taken  at  night,  and  a  little  apenta 
water  in  the  morning. 

(5) — Persons  who  sweat  a  great  deal  ought  to  drink 
plenty  also. 

Cough, — Let  it  be  clearly  understood  that  a  cough  is  not 
a  disease  in  itself,  but  only  a  sign  of  some  disease.  A 
cough  may  show  the  presence  of  indigestion,  for  example, 
being  caused  by  irritating  food  in  the  stomach ;  or  of  bron- 


70  COUGH 

chitis  (inflammation  of  the  air  tubes  in  the  lungs)  ;  or  of 
tuberculous  disease  of  the  lungs  (see  " Consumption")  ;  or 
of  a  relaxed  throat;  or  of  inflammation  of  the  voice  box; 
or  of  a  tumor,  such  as  an  aneurism,  in  the  chest. 

The  first  thing  to  discover  then  is,  what  causes  the  cough? 
To  stop  the  cough  is  not  to  cure  the  disease,  and  sometimes 
it  may  be  even  dangerous  to  stop  a  cough. 

If  the  cough  is  hard  and  short  and  frequent,  it  is  prob- 
ably due  to  indigestion,  and  no  phlegm  is  coughed  up,  or 
"raised,"  as  country  people  say.  If  it  is  hard,  painful, 
brassy  in  sound,  and  later  on  accompanied  by  much  phlegm, 
it  may  be  due  to  bronchitis. 

Children  with  short,  hacking  coughs,  often  have  worms 
in  the  bowels.  Many  infants  cough  during  teething.  A 
sudden  cough  coming  on  at  night,  hoarse,  harsh,  noisy, 
clanging,  and  panting  for  breath,  will  mean  the  disease 
called  croup. 

It  is  impossible,  in  the  limits  of  such  a  book  as  this,  to 
do  more  than  give  the  intelligent  reader  a  general  idea 
about  the  meaning  of  coughs.  As  to  treatment,  it  ought, 
of  course,  to  be  left  to  the  skill  of  a  medical  man.  Yet 
there  are  cases  in  which  some  of  the  following  formulas 
may  be  useful: — 

1.  For  a  croupy  cough. — Ipecacuanha  wine,  antimonial 

wine,  syrup  of  squills — of  each,  2  drachms;  dis- 
tilled water,  to  3  ounces.  For  a  child  of  about  a 
year  old.  A  teaspoonful  to  be  given  every  quarter 
of  an  hour  until  vomiting  occurs ;  then  half  a  tea- 
spoonful  every  three  hours,  until  cured. 

2.  For  winter  cough  in  adults. — A  few  drops  of  tere- 

bene  (pure)  on  a  piece  of  sugar  dissolved  in  mouth 
thrice  daily;  or  a  teaspoonful  of  glyco-heroin  in 
water  every  4  hours  or  so. 

3.  Routine  mixture  for  chronic  bronchitis  in  middle- 

aged  people. — Carbonate  of  ammonia,  24  grains; 
tincture  of  squills,  2  drachms ;  compound  camphor 
tincture,  3  drachms ;  infusion  of  senega,  8  ounces ; 
iodine  of  potash,  24  grains.  A  tablespoonful  of 
this  mixture  may  be  taken  twice  a  day  and  two 
tablespoonfuls  at  bedtime,  additional. 

4.  For  chronic  cough  in  a  rheumatic  person. — Salicylate 

of  soda,  6  drachms ;  glycerin,  %  ounce ;  colchicum 


CEEMATION  71 

root  wine,  6  drachms ;  compound  syrup  of  squills, 
iy2  ounces;  camphorated  tincture  of  opium,  2 
ounces.  Take  a  teaspoonful  in  some  water  every 
four  hours. 

Some  chronic  coughs,  even  if  not  of  a  tuberculous  nature, 
are  benefited  by  cod-liver  oil  and  malt  and  some  require  a 
change  of  climate.  It  must  always  be  borne  in  mind  that 
a  chronic  cough  may  mean  the  beginning  of  consumption. 
Therefore  a  cough  should  never  be  allowed  to  continue  for 
more  than  two  weeks  without  consulting  a  physician  to 
find  out  what  the  cause  of  its  continuance  is.  Remember 
that  an  early  diagnosis  in  pulmonary  tuberculosis  or  con- 
sumption is  half  the  battle  won. 

Cracked  Nipples. — Many  women  who  suckle  children  suf- 
fer from  painful  cracks  and  sores  of  the  teats  of  the  breasts. 
They  ought  to  be  wiped  quite  dry  after  suckling,  and 
glycerin  of  tannic  acid  painted  on  with  a  brush  into  the 
cracks.  Alcohol,  in  the  form  of  methylated  spirit,  or 
spirits  of  wine,  may  be  used  to  bathe  them  if  they  are  soft 
and  tender.  Slight  cracks  may  be  painted  with  flexible  col- 
lodion. (See  also  "Pregnancy,  Hygiene  of.") 

Cramp  in  the  Calf  of  the  Leg. — Many  people  are  occasion- 
ally seized  with  painful  cramps  of  the  calf  muscles  when  in 
bed  at  night.  The  causes  of  such  cramps  are  over  fatigue, 
nervous  exhaustion  and  ' l  goutiness, "  by  which  we  mean 
that  the  body  is  not  able  to  throw  off  waste  matters  through 
skin  and  kidneys,  as  well  as  usual. 

Treatment. —  (1)     Sometimes  smart  rubbing  of  the 
affected  muscles  will  relieve  the  spasm. 

(2)  At  other  times,  applying  tight  elastic  bandage 
round  the  thigh  relieves  the  cramp  at  once. 

(3)  The  calf  muscles  are  used  to  draw  up  the  heel; 
those  which  push  down  the  heel  and  raise  the  foot  are 
' '  antagonistic ' '  to  the  calf  muscles.     It  is  often  a  good 
plan,  then,  to  forcibly  raise  the  foot  by  muscular  action. 

(4)  Massage  of  the  legs  will  cure  bad  cases. 

(5)  Five    grains    of   salicylate    of    soda   swallowed 
thrice  daily,  between  meals,  may  do  good. 

Cremation. — The  number  of  persons  who  agree  with  the 
principle  of  cremating  the  dead  grows  greater  every  year. 


72  CROUP 

Instead  of  consigning  every  corpse  to  the  ground,  there  to 
lie  and  decompose  in  a  wooden  coffin,  and  perhaps  to  con- 
taminate the  underground  watercourses  and  spread  disease 
among  the  living,  many  thoughtful  people  to-day  prefer  to 
destroy  the  lifeless  clay  by  fire,  and  thus  to  purify  it  and 
render  it  harmless  to  the  living.  Every  dead  body  sooner 
or  later  becomes  dust ;  cremation  only  brings  about  the  same 
process  in  a  quick,  cleanly  way,  and  the  furnace  destroys 
at  the  same  time  the  teeming  myriads  of  disease  germs 
which  exist  in  nearly  every  corpse.  Cremation  is  done,  too, 
without  the  smallest  sacrifice  of  sentiment  or  decency,  and 
we  may  well  hope  that  in  coming  years  the  public  at  large 
will  become  so  educated,  so  intolerant  of  the  foulness  of 
disease  and  putrefaction,  that  they  will  gladly  submit  the 
bodies  of  their  loved  ones  to  purification  by  fire,  and  leave 
instructions  in  their  wills  that  their  own  bodies  may  also 
be  thus  cleansed  and  rendered  harmless. 

Cretinism  is  a  medical  word  which  is  applied  to  a  state 
of  stunted  growth,  both  mental  and  physical,  due  to  the 
absence  of  a  soft  gland  called  the  thyroid  gland,  which  is 
situated  under  the  skin  and  muscles,  across  the  lower  part 
of  the  neck  and  windpipe,  and  which  does  lie  there  in  every- 
body except  cretins.  Cretinism  is  common  in  certain  dis- 
tricts. The  cretin  may  live  to  be  a  good  age,  and  is  often 
good-tempered,  quiet  and  fat.  The  skin  is  dry  and  rough, 
the  face  is  vacant  looking,  the  hair  stubbly,  the  hands  short 
and  spade-shaped,  and  there  are  bosses  of  fat  just  over  the 
collar  bones.  These  poor  creatures  often  improve  under 
medical  treatment. 

If  the  thyroid  gland  wastes  away  in  an  adult,  the  adult 
will  generally  become  cretinoid,  but  his  state  is  called 
myxo3dema;  and  he  also  is  susceptible  of  being  improved 
up  to  a  certain  point  by  giving  him  extract  of  thyroid 
gland.  But  though  in  both  these  conditions  it  is  not  diffi- 
cult to  improve  the  body,  it  is  very  hard  to  restore  or 
improve  the  mind. 

Croup. — This  word,  unfortunately  in  common  use  among 
the  poor,  ought  not  to  ~be  used,  because  it  has  been  made  to 
mean  so  many  different  ailments.  Child  crowing  (which 
see)  has  been  also  called  false  croup.  The  name  "false" 
ought  to  be  reserved  for  spasmodic  inflammatory  laryn- 
gitis, or  inflammation  of  the  voice  box,  which  is  accom- 
panied by  noisy  breathing.  The  word  croup  itself  means 


DEAFNESS  73 

"a  noise  in  the  windpipe."     The  right  use  of  these  names 
is  as  follows : — 

False  croup  is  an  inflammation  of  the  larynx,  accom- 
panied by  a  hoarse  noisy  cough  and  difficulty  of  breathing ; 
such  indrawing  of  the  breath  being  accompanied  by  a  coo- 
ing or  crowing  noise.  If  the  child  is  left  alone  the  spasm 
will  probably  pass  off,  and  on  waking  the  child  seems 
almost  well,  but  hoarse.  Attacks  may  occur  again  on  sub- 
sequent nights.  The  medical  names  are  spasmodic  laryn- 
gitis and  inflammatory  croup. 

Membranous  croup  is  probably  always  genuine  diph- 
theria of  the  larynx  and  the  disease  only  resembles  the 
other  kinds  of  croup  in  the  shortness  of  breath  and  a  noisy 
cough.  This  is  also  called  true  croup. 

Spasmodic  croup  is  described  under  the  heading  of 
"Child  Crowing"  (which  see).  It  is  purely  a  nervous  dis- 
ease and  there  is  no  inflammation  about  it.  Mothers  some- 
times call  the  attacks  "passion  fits"  and  "holding  the 
breath."  It  is  apt  to  occur  during  teething.  Its  medical 
name  is  laryngismus  stridulus. 

If  there  is  the  slightest  suspicion  that  an  attack  of  croup 
is  true  croup  or  diphtheria  a  physician  should  be  called 
immediately,  for  in  these  cases  if  diphtheria  antitoxin  can 
be  administered  early  death  rarely  occurs.  If  the  admin- 
istration of  antitoxin  is  delayed  several  days  the  chances 
of  death  are  about  one  in  ten,  while  if  no  antitoxin  is  ad- 
ministered the  chances  of  death  are  much  greater. 

In  any  case  of  suspected  croup  look  for  a  white  diph- 
theritic membrane  on  the  tonsils,  pharynx  or  in  the  nose. 
Sometimes  the  membrane  is  in  the  larynx  and  is  then  in- 
visible to  the  unaided  eye. 

Cut  throat. — A  throat  may  be  cut  by  a  murderer  or  by  a 
suicide.  Death  may  follow  from  loss  of  blood  if  the  large 
blood  vessels  in  the  neck  are  severed;  but  a  wound  of  the 
windpipe  is  not  necessarily  fatal.  If  a  case  is  seen  when 
no  skilled  assistance  is  at  hand,  it  is  probably  best  to  leave 
the  case  alone  and  the  fainting  which  follows  is  the  best 
thing  that  can  happen  to  check  the  flow  of  blood.  Send 
for  a  doctor  and  a  policeman  at  once. 

Deafness. — Do  not  be  misled  into  seeking  temporary  rem- 
edies for  deafness.  Remember  that  it  is  a  sign,  a  symptom, 
and  not  a  disease.  You  must  first  try  to  discover  which 
part  of  the  hearing  apparatus  is  in  fault,  and  then  direct 


74  DEAFNESS 

your  attention  to  remedying  the  fault  if  possible  (see  also 
"Ear  Diseases").  In  most  cases,  at  the  outset,  and  in  an 
early  stage  of  deafness  without  pain,  you  may  syringe  out 
the  ear  with  a  glass  syringe  (or,  better  still,  an  india  rubber 
enema  syringe),  and  a  lotion  made  of  a  teaspoonful  of 
baking  soda  in  half  a  pint  of  warm  water.  Continue  until 
all  "wax"  and  dirt  and  dried  discharge  have  been  washed 
away.  Dry  with  a  towel,  and  not  by  poking  in  a  piece  of 
cotton-wool  on  the  end  of  a  hairpin !  If  there  be  still  some 
wax,  leave  a  bit  of  cotton-wool  soaked  in  a  very  strong  soda 
solution,  in  the  ear  for  a  few  hours;  then  squirt  again. 
If  the  ear  is  too  tender  to  allow  this  to  be  done  properly, 
put  a  poultice  on  the  side  of  the  head;  or,  better  still,  a 
hot  onion  (see  "Poultices").  If  now  the  deafness  is  not 
gone,  it  must  be  caused  by  catarrh,  which  makes  the  mucous 
membrane  lining  the  whole  hearing  apparatus  swollen  and 
hot,  and  interferes  in  several  ways  with  hearing.  There  is 
no  "certain  cure"  for  this  catarrh;  there  is  no  "cure"  at 
all,  really.  You  cannot  learn  too  soon  that  a  catarrh  is 
only  the  local  sign  of  a  general  constitutional  weakness. 
You  may  apply  douches,  ointments,  gargles,  drops,  etc.,  as 
much  as  you  like,  and  they  are  all  useful  to  relieve  the 
discomfort;  but  they  will  not  cure.  A  nasal  catarrh,  like 
every  other  catarrh,  must  be  cured  by  improving  the  bodily 
health,  and  specially  by  change  of  air.  You  must  call  the 
doctor  in  to  prescribe  lotions,  douches  and  drops  that  may 
be  necessary  to  your  special  case;  but  you,  yourself,  must 
see  to  the  cure.  You  must  live  in  a  well-ventilated  house ; 
must  have  the  window  open  at  night;  must  dress  lightly 
but  warmly  and  use  no  such  unwholesome  clothes  as  eider- 
downs and  the  furs  of  dead  animals.  You  must  eat  all 
you  are  able  to,  chewing  the  food  well.  You  must  rest  in 
bed  enough;  you  must  indulge  in  no  bad  habits  (see  "Hy- 
gienic Misdemeanors"),  and  take  no  unnecessary  stimu- 
lants. Little  by  little,  as  time  goes  on,  your  general  health 
will  improve  and  your  liability  to  catarrhs  will  be  con- 
quered, and  you  need  spend  no  more  on  deaf-curing  insti- 
tutes or  medicines.  If  your  weakness  is  hereditary  so  much 
the  worse  for  you,  and  the  harder  you  must  fight,  and  the 
less  dissipation  you  can  afford.  But  catarrhal  deafness  is 
not  to  be  cured  by  medicines  (though,  of  course,  good  medi- 
cal advice  and  treatment  are  necessary  to  help  you  on  your 
way),  but  by  living  hygienically  and  wholesomely. 


DEATH,  SUDDEN  75 

Death,  Sudden. — We  are  not  going  to  say  anything  about 
death  which  occurs  suddenly  as  the  result  of  an  injury  or 
an  accident.  We  are  referring  only  to  sudden,  unforeseen 
death  occurring  in  a  person  whom  we  had  supposed  to  be 
in  no  immediate  danger  of  dying  at  all. 

No  one  dies  suddenly,  apart  from  the  effects  of  violence, 
as  long  as  all  his  organs  are  sound.  But  there  are  diseases 
which  develop  slowly  and  secretly,  without  letting  the  pa- 
tient know  of  their  existence  by  pain  or  feeling  of  illness. 
Not  absolutely  without  signs,  we  mean;  but  without  signs 
enough  to  alarm  the  patient,  though  his  doctor  may  know 
at  a  glance  that  he  is  liable  to  die  suddenly.  For  example, 
a  man  with  advanced  disease  of  his  blood  vessels  may  only 
complain  occasionally  of  a  little  indigestion,  or  flushing,  or 
shortness  of  breath.  A  man  with  diabetes  eats  heartily, 
sleeps  well,  and  is  cheerful,  but  he  may  die  to-morrow  all 
the  same.  One  cause  of  sudden,  unforeseen  death  is  fatty 
heart,  probably  caused  by  the  patient's  own  faulty  mode 
of  life,  or  indulgence  in  alcohol.  Another  cause  is  valvular 
heart  disease  which  may  exist  for  years,  and  only  kill  when 
the  poor  overworked  heart  is  suddenly  overtaxed.  Another 
cause  is  the  dreadful  angina  pectoris,  or  breast  pang — a 
sudden,  terrific  pain  at  the  heart,  a  sense  of  impending 
death — and  then  sudden  death,  or  absolute  recovery.  Some 
people  have  three  or  four  attacks  of  real  angina  before 
one  carries  them  off.  This  is  not  the  same  as  the  acute 
attacks  of  heart  pain  that  so  many  hysterical  females  com- 
plain of.  Those  are  often  due  to  wind  in  the  stomach,  and 
do  not  cause  death !  The  bursting  of  an  aneurism,  or  blood 
tumor,  occasionally  causes  death — unforeseen,  because  an- 
eurisms occasionally  exist  quite  unsuspected,  especially  in 
robust  and  hard-working  mechanical  laborers. 

Another  set  of  causes  is  connected  with  the  brain,  and 
are  such  as  tumors  of  the  brain,  and  bleeding  into  the  head, 
between  the  brain  and  the  skull.  People  with  epilepsy 
sometimes  die  suddenly  in  a  fit.  In  the  Reign  of  Terror, 
and  doubtless  occasionally  since  also,  death  has  occurred 
from  emotion — terror,  rage,  or  despair,  and  even  joy. 
Tight-lacing  has  caused  sudden  death.  Then  there  are 
deaths  from  sunstroke ;  a  great  many  people  die  every  year 
in  New  York  from  that  cause.  Some  even  die  of  heat 
stroke  in  the  depths  of  a  shady  wood,  or  while  watching  a 
great  house  on  fire.  In  Russia  cold  kills  about  700  people 


76  DELIRIUM  TREMENS 

every  year.  A  few  children  die  every  year,  with  sudden- 
ness, as  the  result  of  tobacco  smoking.  Very  stout  people 
are  apt  to  die  of  sudden  heart  failure,  especially  during 
exercise  after  over-eating,  or  while  walking  up  a  hill. 
Anaemic  girls,  who  are  so  often  the  victims  of  the  indiges- 
tion due  to  ulcer  of  the  stomach,  sometimes  die  suddenly. 
This  is  due  to  the  shock  caused  by  the  ulcer  perforating 
through  the  stomach  wall  and  the  food  escaping  into  the 
cavity  of  the  belly ;  where  it  soon  sets  up  peritonitis.  Per- 
sons with  gastric  ulcer  go  about  in  hourly  danger  of  this 
peritonitis,  and  this  complaint  ought,  therefore,  never  to  be 
neglected. 

Delirium  Tremens. — DRINK  MADNESS. — In  the  career  of 
the  moderate  drinker  there  is  sometimes  an  occasional  de- 
bauch. The  excess  is  taken,  the  intoxication  is  passed 
through,  the  long  sleep  that  follows  allows  nature  to  recover 
somewhat,  and  only  a  little  indigestion  remains,  or  perhaps 
not  even  that.  This  is  melancholy  enough,  seen  as  a  spec- 
tacle of  human  weakness;  but  we  are  accustomed  to  think 
that  "there  is  not  much  harm  done."  In  the  case  of  an 
habitual  drinker  to  excess  things  are  different.  A  tem- 
porary excess  in  his  case  is  very  likely  to  bring  on  what  is 
called  drink  madness,  or  delirium  tremens.  Any  accident, 
fall,  shock,  or  an  acute  inflammation  may  bring  on  this 
serious  condition.  The  man  is  restless,  irritable,  and  can- 
not sleep ;  so  he  flies  to  alcohol  to  calm  him — in  pain.  He 
begins  to  talk  incessantly,  and  to  fidget  about,  or  rush 
violently  from  place  to  place.  His  talking  becomes  mutter- 
ing, his  muttering  grows  incoherent.  He  has  horrid  vi- 
sions— rats,  snakes,  and  crawling  reptiles  glide  about  his 
bed,  and  he  hears  the  roars  of  devouring  beasts,  and  the 
voices  of  enemies  conspiring  to  kill  him.  He  attempts  to 
jump  out  of  the  window.  He  cannot  sleep,  he  trembles, 
cries,  groans  and  raves,  and  will  not  eat  or  drink. 

On  the  third  or  fourth  day  he  dies  of  exhaustion,  unless 
he  has  been  properly  treated,  in  which  case  the  restlessness 
abates,  sleep  at  last  comes  to  his  rescue,  and  he  improves 
until  he  is  cured.  For  a  time  he  has  been  thoroughly 
frightened.  He  realizes  his  weakness  and  sin,  and  per- 
haps rushes  to  sign  the  pledge.  Unfortunately,  the  drink- 
ing habit,  once  fully  established,  is  rarely  abandoned.  But 
every  man  must  decide  for  himself.  If  he  cannot  drink 


DENTAL  HYGIENE  77 

moderately,  without  occasional  excess,  let  Mm  be  manly 
enough  to  abstain  altogether.  The  golden  mean  is  only  for 
the  strong  and  self-respecting. 

Treatment. — Even  in  the  mildest  case  the  patient  must 
be  treated  as  insane  for  the  time  being,  and  the  doctor  will 
consider  it  his  duty  to  impress  upon  the  friends  that  the 
sick  man  cannot  be  trusted  out  of  sight  for  a  moment. 
He  has  horrid  delusions,  and  at  any  moment  he  may  commit 
suicide,  or  murder.  His  room  ought  to  be  in  darkness,  and 
he  in  bed.  To  nurse  him  will  require  great  courage  and 
great  tact,  so  as  not  to  increase  the  struggles.  It  is  a  good 
plan  to  put  a  sheet  across  him  and  tie  down  the  corners 
and  tuck  in  the  ends.  Strong  soups,  jellies,  beef  essences, 
and  plenty  of  milk  must  be  administered  as  often  as  the 
patient  will  take  them.  It  may  be  necessary  to  feed  him 
forcibly  through  a  tube. 

We  shall  advise  no  drugs.  Sometimes  drug  after  drug 
is  given  to  produce  sleep  and  no  sleep  comes,  and  after- 
wards the  drugs,  which  have  been  lying  undigested  in  the 
body,  suddenly  take  effect  and  poison  the  patient  afresh. 
Only  a  doctor  can  know  whether  or  not  to  give  drugs  and 
when  to  do  so. 

Dental  Hygiene , — The  importance  of  taking  care  of  the 
teeth  and  preventing  their  decay  is  appreciated  when  we 
realize  that  in  a  recent  survey  of  school  children  97  per 
cent,  of  the  boys  and  girls  were  found  to  have  teeth  in  a 
diseased  condition.  This  means  that  all  through  their  lives 
— unless  their  teeth  are  filled  or  replaced  by  false  ones — 
they  will  be  unable  to  chew  their  food  properly,  will  suffer 
from  indigestion  and  malnutrition,  and  every  time  they 
swallow  they  will  swallow  disease  germs  which  lurk  in  the 
(Jirty  cavities  of  diseased  teeth.  The  result  will  be  a  con- 
stant low  grade  poisoning  which  will  do  much  to  impair 
their  health  efficiency  and  happiness  in  after  life. 

This  being  the  case  what  precautionary  measures  can  be 
taken  to  avoid  having  the  teeth  become  diseased? 

The  teeth  ought  to  be  brushed  after  every  meal.  If  this 
cannot  always  be  done  we  should  at  least  take  great  care 
to  clean  them  just  before  bedtime  and  before  breakfast. 

The  teeth  should  be  brushed  up  and  down  as  well  as 
crossways.  The  backs  should  be  brushed  as  well  as  the 
fronts.  It  is  well  after  cleaning  to  draw  a  silk  thread  in 


78  DIABETES 

and  out  between  the  teeth  to  take  away  any  bits  of  food 
which  may  have  caught  there  and  which  will  ferment  if 
allowed  to  remain. 

Tooth  powder  is  of  service  in  keeping  the  teeth  clean; 
but  none  but  alkaline  tooth  powders  should  ever  be  used, 
as  acids  spoil  the  teeth. 

Every  morning  and  evening  an  alkaline  mouth  wash 
should  be  used.  A  good  example  of  such  a  mouth  wash  is 
alkalol,  or  the  official  Liquor  Antisepticus  Alkalinus. 

Once  every  six  months  the  teeth  should  be  cleaned  by  a 
dentist  in  order  that  tartar  which  collects  about  the  bases 
of  the  teeth  can  be  removed. 

Offensive  breath  usually  comes  from  decaying  food  par- 
ticles which  are  allowed  to  remain  between  and  about  the 
teeth. 

A  good  inexpensive  tooth  powder  may  be  made  up  by 
your  druggist  as  follows: — 

Bicarbonate  of  soda,  y2  ounce ;  precipitated  chalk,  2 
ounces;  pulverized  orris  root,  1  ounce;  pulverized 
Castile  soap,  1  ounce.  Flavor  with  peppermint  or 
wintergreen. 

A  dirty  mouth  full  of  disease  germs  is  not  only  dan- 
gerous to  the  owner,  but  to  his  associates  as  well,  for  every 
spray  from  such  a  mouth  in  coughing,  sneezing,  or  even 
talking  or  reading,  is  laden  with  microbes  which  vitiate 
the  air  to  be  breathed  by  others. 

Do  not  forget  that  nature 's  method  of  brushing  the  teeth 
is  by  chewing  foods  having  considerable  firmness  of  con- 
sistency. 

This  is  the  reason  why  the  teeth  of  dogs  and  bears  are 
usually  in  such  good  condition. 

Therefore  it  is  well  to  include  in  one's  dietary  foods 
which  must  be  chewed  to  be  swallowed,  and  then  to  be  sure 
to  chew  them  sufficiently  before  they  are  passed  on  to  the 
stomach  for  digestion. 

Diabetes. — There  are  two  forms  of  diabetes,  distinct  dis- 
eases, but  both  characterized  by  the  daily  passage  of  too 
large  a  quantity  of  urine.  Diabetes  insipidus  is  a  nervous 
disease,  chiefly  of  children,  who  suffer  from  intense  thirst 
and  an  excessive  amount  of  urine,  which,  however,  contains 
nothing  unusual. 


DIABETES  79 

Diabetes  Mellitus  is  much  more  common.  The  symptoms 
of  it  are  these : — 

(1)  Loss  of  weight  and  increase  of  weakness. 

(2)  Continual  thirst. 

(3)  Frequent  desire  to  pass  water  and  the  passage 
of  large  quantities  of  it  every  day.     The  normal  person 
passes  about  3  pints  a  day   (see  ll Urine  Troubles ")» 
but  the  diabetic  passes  as  much  as  20  or  30  pints  a  day 
sometimes. 

(4)  The  urine  is  sweet    (it  contains  grape-sugar), 
very  pale  in  color,  is  irritating  to  the  private  parts, 
and  often  causes  itching  and  skin  eruptions. 

(5)  The  appetite  is  sometimes  enormous. 

(6)  The  breath  often  smells  sweet,  as  of  apples. 

(7)  Skin  eruptions  of  all  kinds,  especially  eczemas, 
are  common. 

(8)  Indigestion,  decay  of  the  teeth,  dry  harsh  skin, 
are  common  signs. 

Causes. — Disease  of  the  pancreas  (sweetbread)  is  con- 
sidered to  be  one  cause  of  the  symptoms.  The  liver  is  evi- 
dently at  fault,  too,  for  the  liver  is  the  organ  which  deals 
with  the  starches  and  sugars  taken  in  the  food,  and  which 
ought  to  store  them  up  (as  sugar)  for  future  use,  instead  of 
letting  them  escape  by  the  urine.  The  immediate  causes 
are  not  known  either;  too  much  brain  work,  too  much 
worry,  too  much  business  strain  may  all  cause  an  attack. 
Engine  drivers  suffer  particularly  from  the  nerve  strain 
they  experience. 

There  are  three  more  or  less  definite  types  of  cases  of 
diabetes: — 

(1)  Young  patient,  with  much  sugar  in  the  urine, 
with  chest  complications   and  general   debility.     The 
escape  of  sugar  cannot  be  controlled  much  by  the  use 
of  drugs  or  dieting,  and  the  disease  is  fatal  in  a  few 
months. 

(2)  Middle-aged  patient,  with  sugar  leakage,  which 
can  be  controlled  to  a  large  extent  by  suitable  treat- 
ment and  drugs,  and  which  may  last  for  from  two  to 
four  years. 

(3)  Elderly  patient,  in  whom  all  the  symptoms  are 
not  very  severe,  and  who  gets  great  benefit  from  medi- 


80  DIET  FOR  DIABETES 

cines  and  dieting,  but  who  dies  at  last  from  consump- 
tion of  the  lungs  or  coma  after  many  years. 

The  complications  of  diabetes  may  be : — 

Neuritis  and  paralysis,  various  skin  diseases,  kidney 
diseases,  cataract,  carbuncles,  collapse  or  coma  (in- 
sensibility), gangrene  (of  lung,  or  of  toes  or  fingers). 

Coma,  in  diabetes,  accounts  for  the  deaths  of  about  half 
the  total  number  of  patients.  It  may  come  on  quite  sud- 
denly as  the  result  of  an  injury,  or  merely  of  fatigue.  The 
patient  becomes  collapsed,  his  breathing  is  slow,  then  very 
slow,  and  his  breath  smells  sweet  (as  of  hay  or  apples), 
and  he  quietly  becomes  unconscious  and  insensible  and  dies 
at  last  without  moving.  Nothing  can  be  done  when  coma 
comes  on. 

Note  about  diabetes. — Persons  who  suffer  from  boils, 
eczema,  carbuncles,  itching  of  the  privates,  too  much  ap- 
petite, continual  thirst,  loss  of  sexual  power  or  desire, 
ought  to  take  a  specimen  of  their  urine  to  a  doctor  and 
ask  him  to  examine  it  for  sugar.  They  may  have  early 
diabetes. 

Treatment  of  diabetes. — This  consists  almost  entirely  in 
suitable  dieting  and  the  use  of  opium  as  a  medicine.  As 
to  the  dieting  we  are  obliged  to  say  that  no  two  cases  of 
the  disease  do  well  on  the  same  dietary.  So  that  no  dia- 
betic patient  can  possibly  do  without  a  doctor.  The  great 
point  about  the  diet  is  that  it  must  contain  as  little  as 
possible  of  either  sugar  or  starch. 

Every  week  of  his  life  the  patient  ought  to  weigh  him- 
self, estimate  the  amount  of  sugar  in  his  urine  (which  he 
can  learn  to  do  for  himself),  and  adjust  both  diet  and 
medicine  from  time  to  time  in  accordance  with  what  he 
notices  about  the  sugar  and  his  own  comfort  in  life.  We 
can  lay  down  no  hard  and  fast  rules ;  but  here  are  two  lists 
which  may  help  some  diabetic  patient  to  diet  himself: — 

He  must  not  eat — Potatoes,  turnips,  carrots,  cauliflower, 
peas,  beans,  seakale,  apples,  pears,  oranges,  gooseberries, 
currants,  plums,  peaches;  cornflour,  bread,  rice,  sago,  tapi- 
oca, confectionery,  pastry,  liver ;  sugar  of  any  kind. 

He  may  eat — Any  kind  of  meat,  game,  poultry,  or  fish; 
all  green  vegetables ;  cheese,  butter,  eggs,  saccharin  or  saxin 
in  place  of  sugar;  nuts.  The  only  real  difficulty  is  in  the 


DIARRHEA  81 

matter  of  bread.  Bran  bread,  gluten  bread,  toasted  thin 
slices  of  baker's  bread,  almond  cakes,  cocoanut  cakes,  may 
be  eaten. 

The  question  of  drinks  must  be  left  to  the  doctor ;  and  so 
must  that  of  medicine.  Codeine  (from  opium)  still  re- 
mains the  best  drug  to  use  in  most  cases. 

Diarrhea. — Diarrhea  is  of  frequent  occurrence,  and  it 
arises  from  very  different  causes,  and  exists  from  the  pres- 
ence of  many  different  diseased  states.  In  infancy  it  is 
commonly  due  to  improper  feeding,  to  over-feeding  with 
milk,  or  too  early  use  of  starchy  foods  with  the  milk,  or 
to  the  use  of  bottles,  tubes,  and  teats  insufficiently  cleansed, 
or  to  the  use  of  milk  food  which  has  turned  sour  from 
staleness,  or  hot  close  weather,  or  from  being  kept  in  rooms 
with  foul  air.  If  an  infant  has  frequent  diarrhea,  in  the 
absence  of  all  these  causes,  there  is  a  danger  that  the  child 
has  tuberculous  or  consumptive  disease  of  the  bowels,  which 
is  a  most  dangerous  ailment.  In  older  children  diarrhea 
is  almost  always  set  up  by  errors  of  diet,  especially  by 
unsound  fruit,  and  unwholesome  foods.  In  adults  occa- 
sional attacks  of  diarrhea  are  also  generally  due  to  im- 
proper food,  or  to  some  gross  excess  in  some  article  of  diet 
or  of  drink.  Impure  drinking  water  from  public  courses, 
or  from  private  wells,  or  drunk  from  dirty  cisterns,  may 
also  produce  diarrhea.  The  presence  of  many  decayed 
teeth,  causing  faulty  digestion,  is  also  a  fertile  cause  of 
upset  bowels,  with  colic  pains  and  frequent  loose  stools. 
In  addition  to  these  various  reasons  for  the  presence  of  diar- 
rhea, it  must  be  remembered  that  it  may  be  due  to  the  pres- 
ence of  serious  organic  disease  or  to  typhoid  fever.  Chronic 
intemperance,  which  has  partly  destroyed  the  liver,  is  often 
accompanied  by  a  form  of  diarrhea,  which  rapidly  reduces 
the  strength  of  the  sufferer.  Phthisis,  or  consumption  of 
the  lungs,  in  its  later  stages,  is  in  many  instances  ac- 
celerated by  very  persistent  and  exhausting  diarrhea, 
which  is  due  to  tuberculous  ulceration  in  the  intestines. 
In  typhoid  or  enteric  fever  also  the  looseness  of  the  bowels 
results  from  a  peculiar  form  of  ulceration  in  the  coats 
of  the  large  intestine.  Acute  attacks  of  severe  diarrhea 
also  occur,  generally  in  autumn  in  this  country,  in  an 
epidemic  form;  these  are  sometimes  called  cholera  morbus. 

Treatment. — When  diarrhea  is  set  up  by  offending  mat- 
ters in  the  bowels,  it  is  first  necessary  to  effect  complete 


82  DIARRHEA  IN  BABIES 

removal  by  some  simple  non-irritating  purgative  dose,  such 
as  castor  oil,  or  compound  senna  mixture,  or  by  Epsom 
salts,  with  peppermint  or  ginger ;  and  then,  later,  to  ad- 
minister sedatives  and  astringents,  such  as  chalk  mixture, 
aromatic  confection,  or  paregoric.  But  if  the  diarrhea 
be  due  to  ulcerations  in  the  bowels  the  highest  medical  skill 
may  be  needed  to  keep  it  under  control  by  means  of  more 
powerful  medicines  and  special  care  in  diet. 

Here  follow  some  formulas  which  if  used  with  discretion 
and  intelligence  may  be  found  useful : — 

For  Summer  Diarrhea,. — Bicarbonate  of  soda,  4  grains ; 
rhubarb  powder,  1%  grains;  cinnamon  powder,  1 
grain; — for  one  powder.  A  child  of  one  year  old 
may  take  this  powder  twice  a  day.  A  dose  of  castor 
oil  with  10  drops  of  laudanum  in  it  will  often  check 
diarrhea. 

For  Alcoholic  Diarrhea. — Take  a  two-grain  pill  of 
capsicum  every  four  hours. 

Chronic  Diarrhea. — Take  a  two-grain  pill  of  acetate 
of  lead  every  four  hours.  (See  also  " Diarrhea  in 
Babies.") 

Diarrhea  in  Babies. — Diarrhea  in  babies  is  generally  a 
sign  of  inflammation  of  the  intestines  (enteritis)  caused  in 
the  first  place  by  unsuitable  food,  and  kept  up  by  the  want 
of  nourishment,  which  follows  as  a  matter  of  course.  ( This 
disease  is  often  spoken  of  among  the  poor  as  "consumption 
of  the  bowels, ' '  but  need  not  be  connected  with  tuberculous 
disease).  If  the  mother  looks  at  the  child's  "motions"  in 
the  napkins  she  will  see  that  they  consist  generally  of  masses 
of  lumpy  curd  (undigested  cow's  milk),  rather  like  clots 
of  putty  in  appearance,  smelling  badly  and  greenish  in 
color.  Along  with  the  curdy  mess  is  a  little  acrid  greenish 
discharge,  which  the  nurse  is  apt  to  suppose  to  be  urine, 
but  which  comes  really  from  the  intestine.  If  opiates, 
soothing  syrups,  or  vegetable  astringents  (such  as  aro- 
matic powders)  are  given,  the  baby  will  probably  get  worse 
and  perhaps  die.  The  child  vomits,  and  sinks  into  an 
exhausted  state,  due  simply  to  lack  of  nourishment.  The 
greatest  mistake  is  to  continue  to  administer  cow's  milk, 
which  the  child  cannot  digest.  Dr.  Lennox  Wainwright 
recommends  in  these  cases  a  diet  mainly  of  albumen  water. 
This  is  made  of  the  white  of  a  raw  egg,  beaten  up  with 


DIPHTHERIA 


half-a-pint  of  water,  and  sweetened  with  sugar  and  milk. 
Alternate  feeds  may  consist  of  whey  (made  with  rennet 
and  milk  and  cream).  No  ordinary  cow's  milk  may  be 
given.  The  only  medicine  required  is  gray  powder  in 
doses  of  half-a-grain  or  so,  according  to  the  baby's  age. 

Digestibility  of  various  kinds  of  food.  An  ordinary 
dinner  of  soup,  meat,  vegetables,  bread,  pudding  and 
cheese,  is  digested  in  from  four  to  five  hours.  Some  of 
the  ingredients  are  more  digestible  than  others.  The  fol- 
lowing table  gives  approximately  the  hours  required  for 
the  digestion  in  the  stomach  of  some  of  the  principal 
foods : — 


HOURS 

Beef,  boiled 3 

"       roast    3—4 

"       grilled     4—5 

Cheese    3 — 4 

Cabbage 3| — 4 

Carrots     3 — 3i 

Eggs,  raw    2 

"        fried  or  boiled    3— 3J 

"    _  hard-boiled     3|— 4 

Goost,   roast    4 — 5 

Fish,  boiled 1  \ — 2J 

Ham,  boiled    2 — 3 

Lamb    2J 

Apples    


HOURS 

Mutton,   boiled    3 

roast    3— 3i 

Milk     2 

Oysters,   raw    2 

Potatoes,  boiled  2£ — 31 

Pork   roast    5 

Poultry    2£— 4 

Tripe    1 

Turnips    3| — 4 

Rice     1—2 

Sago     1 — 2 

Tapioca   1 — 2 

Wheat  Bread   3 — 4 

3 — 4  hours. 


Diphtheria. — This  is  a  disease  in  which  there  is  inflam- 
mation of  the  throat  chiefly,  but  also,  sometimes,  of  the 
lining  of  the  nose  and  air  passages.  What  is  called  a 
''false  membrane"  is  formed  on  the  parts  affected.  This 
is  a  whitish,  tough  substance,  which  covers  a  red,  inflamed 
and  tender  place.  The  disease  does  not  begin,  as  a  rule, 
suddenly,  but  the  sufferer  complains  of  a  bad  sore  throat, 
and  tenderness  and  swelling  at  the  angle  of  the  jaw,  head- 
ache, and  sickness.  He  is  feverish  and  ill,  and  so  power- 
ful is  the  poison  of  the  disease,  caused  by  a  germ  called 
the  bacillus  of  diphtheria,  that  the  sick  child  (it  is  very 
often  a  child  under  twelve  years)  becomes  rapidly  ex- 
hausted, and  may  die  suddenly  of  heart  failure,  or  of 
suffocation.  This  disease  is  contagious,  especially  if  one 
comes  in  contact  with  the  sneezes  or  coughed-up  phlegm 
of  the  child. 

A    child   with   diphtheria   gets   rapidly   worse,    coughs, 


84  DIPSOMANIA 

tosses  restlessly  in  bed,  gasps  and  wheezes.  A  doctor  must 
be  called  at  once.  If  he  is  called  as  soon  as  there  is  a  sore 
throat,  he  will  inject  a  substance  called  antitoxin,  which 
will  soon  cure  the  disease.  Diphtheria  is  too  serious  a 
matter  for  any  amateur  doctoring,  and  so  we  shall  say 
nothing  about  the  treatment  of  it.  But  it  is  important 
that  the  reader  should  know  how  serious  may  be  the  com- 
plications and  sequels  of  the  disease. 

First  of  all,  a  child  with  diphtheria  of  the  throat  and 
air  tubes  may  be  suffocated  at  any  moment,  and  a  doctor 
must  be  on  the  alert  ready  at  any  time  to  perform  trache- 
otomy, that  is,  to  make  an  opening  in  the  windpipe  for 
the  patient  to  breathe  through.  Secondly,  the  child's  pulse 
must  be  carefully  watched  by  the  doctor  in  order  to  stave 
off  exhaustion,  or  else  he  may  die  suddenly.  Thirdly, 
pleurisy  or  pneumonia  may  develop.  Fourthly,  a  few  days, 
or  even  weeks,  after  apparent  recovery,  the  child  may  be- 
gin to  talk  through  his  nose,  and  to  choke  over  his  food. 
These  signs  are  caused  by  paralysis  of  the  palate  of  the 
mouth,  due  to  the  diphtheritic  poison.  He  may  also  squint, 
or  become  weak  in  the  legs.  He  may  even  die  of  paralysis 
of  the  heart.  Generally,  however,  he  recovers  in  a  few 
weeks. 

The  chief  things  to  remember  in  these  cases  are,  to  be 
careful  not  to  catch  the  breath  of  the  patient ;  to  nurse  him 
in  a  room  empty  of  everything  except  really  necessary 
furniture;  to  hang  a  sheet  wetted  with  carbolic  acid  over 
the  room  door;  to  use  plenty  of  disinfectants;  to  give  the 
child  no  toys  or  books  that  cannot  be  burnt  afterwards ;  and 
to  keep  everyone  out  of  the  room  except  the  nurse  and 
the  doctor. 

Dipsomania. — This  is  a  form  of  drunkenness  in  which 
the  drunkard  drinks  to  excess  in  bouts,  or  paroxysms,  and 
then  goes  for  some  time  without  drinking  at  'all.  Dur- 
ing the  attack  the  dipsomaniac  drinks  because  he  has  a 
craving  to  do  so,  which  he  has  no  strength  to  resist  (and, 
perhaps,  in  some  cases,  no  desire  either)  ;  and  in  the  in- 
tervals he  does  not  drink  because  he  suffers  from  remorse, 
and  has  been  made  thoroughly  ill  besides;  and,  perhaps, 
because  the  craving  is  absent,  and  he  has  lost  for  the  time 
all  desire  for  alcohol.  When  the  end  of  the  period  of 
abstinence  is  over  the  craving  comes  back  again,  and,  if 


DISINFECTION  85 

he  has  any  moral  courage  left,  he  will  fight  against  the  de- 
sire until  either  he  or  the  demon  is  conquered.  But  in- 
dulgence in  alcohol  weakens  everyone's  moral  nature,  and, 
by-and-bye,  he  cannot  resist  drinking,  even  though  he  may 
wish  to  do  so  with  all  his  unhappy  soul.  This  is  one  of 
the  laws  of  the  disease  of  drunkenness — the  fact  that  the 
craving  is  periodical.  It  is  easy  for  people  to  fancy  that 
if  a  dipsomaniac  can  stop  for  six  weeks  he  could  easily 
stop  during  the  seventh  also,  if  he  liked.  It  is  not  the 
case.  Just  as  in  ague  or  malaria,  the  attacks  come  on  more 
or  less  regularly,  and  leave  the  patient  fairly  well  between 
times,  so  in  dipsomania,  when  the  craving  comes  he  falls 
into  the  slavery — he  becomes  again  a  victim  to  the  poison- 
ous drug  habit,  and  is  no  more  free  than  the  sufferer  from 
ague  is. 

Now,  from  what  has  been  said,  it  will  be  seen  that  to 
cure  drunkenness,  two  things  are  necessary — one,  to  stop 
the  supply  of  alcoholic  poison,  which  weakens  the  moral 
and  physical  resistance  against  itself;  and  the  other,  to 
break  up  the  rhythmic  regularity  of  the  attacks,  to  in- 
terfere with  their  periodicity.  These  things  are  what 
honest  systems  of  cure  aim  at  doing.  In  the  intervals  the 
drunkard  is  fed  up  and  rested  and  encouraged,  so  that 
the  ravages  of  the  poison  may  be  met  by  as  strong  a  body 
as  possible ;  and  then,  when  the  attack  comes  on,  he  is  put 
under  restraint,  so  that  he  cannot  possibly  obtain  the  poison 
which  will  ruin  him,  body  and  soul. 

Disinfection. — After  every  case  of  contagious  disease  and 
advisedly  after  every  case  of  infectious  disease  the  room 
and  fabrics  in  contact  with  the  case  should  be  disinfected. 
A  disinfectant  is  an  agent  capable  of  destroying  the  in- 
fective power  of  infectious  material. 

The  most  effective  disinfectants  are  fire,  steam  and  heat. 

These  will  kill  anything.  The  most  useful  disinfectant 
for  room  purposes  is  formaldehyde  gas. 

After  closing  all  cracks  and  crevices  in  a  room  by  cotton, 
adhesive  plaster  or  paper,  one  pound  of  unslaked  lime  may 
be  put  in  a  tin  basin  resting  on  bricks  and  on  this  is  poured 
y2  pint  of  40%  formalin.  This  is  sufficient  for  1000  cu. 
ft.  of  space.  The  room  should  remain  sealed  for  6-8 
hours. 

Formaldehyde  gas  may  be  made  for  this  purpose. 


86  DOSAGE 

Sulphur  is  frequently  used,  but  is  not  as  good  as  for- 
maldehyde although  it  will  destroy  vermin,  which  for- 
maldehyde will  not  do.  For  each  1000  cu.  ft.  to  be  disin- 
fected 3  Ibs.  of  sulphur  are  to  be  burned.  The  heat  gen- 
erated by  burning  sulphur  is  so  great  that  the  pan  con- 
taining it  should  rest  on  bricks — not  on  a  wooden  floor 
directly. 

These  gases  do  not  penetrate  fabrics  very  far. 

Chloride  of  Lime,  and  trikresol  are  good  disinfectants 
for  discharges  from  patients. 

Bichloride  of  mercury  (1-500)  is  useful  in  the  disin- 
fection of  bed  clothing. 

Lime  in  the  form  of  whitewash  is  a  capital  form  of  cheap 
disinfectant  for  country  buildings  and  outhouses. 

Among  the  proprietary  disinfectants  may  be  mentioned 
Platt's  Chlorides,  C.  N.  Disinfectant  and  the  English 
Sanitas  Fluid. 

Dislocation  generally  means  that  the  bones  of  a  joint 
are  displaced,  and  this  has  been  done  by  violence  of  some 
kind.  Every  joint  in  the  body  is  liable  to  be  the  seat  of 
dislocation,  but  dislocations  of  the  collar  bone,  elbow,  ankle, 
and  jaw,  are  most  common. 

The  non-medical  person  cannot  generally  distinguish  be- 
tween a  dislocation  of  a  joint  and  a  fracture,  or  break- 
age, of  the  bone.  Sometimes  the  bone  is  broken  and  dis- 
placed also.  The  notable  thing  about  most  simple  dis- 
locations is  that  a  joint  which  usually  moves  freely  has 
become  fixed.  Of  course  a  dislocated  collar  bone  is  an  ex- 
ception to  this,  but  it  may  be  known  by  a  lump  in  an  un- 
usual situation.  No  one,  who  is  not  a  doctor,  can  possibly 
hope  to  "reduce  the  dislocation"  or  put  back  the  bone  into 
its  place  without  a  serious  risk  of  doing  more  damage  to 
the  joint.  In  the  case  of  a  dislocation  of  the  jaw  the  pa- 
tient's mouth  is  open,  and  he  cannot  close  it.  It  may  be 
out  of  joint  on  one  or  on  both  sides  at  the  same  time.  It 
may  occur  during  yawning.  Nearly  every  dislocation  is 
accompanied  by  a  sprain  and  a  bruise;  so  refer  to  the 
articles  on  those  subjects. 

Dosage. — When  the  dose  of  a  medicine  is  mentioned  in 
this  book,  it  is  a  dose  which  would  suit  an  adult.  To  find 
out  what  dose  to  give  a  child  or  infant,  consult  the  fol- 
lowing table : — 


DRACHMS  AND  OUNCES 


87 


For  example,  if  t 

he  Adult  Dose: 

For  a  Child  of 

Give 

Be    One    Drachm; 
(or    60    grains,    or 

If    One    Ounce; 
(or  two  table- 

60  minims). 

spoonfuls). 

Less  than  1  year  old 

y1^     of     adult 

give  5    grains 

40  minims 

dose 

«       «     2      " 

i  of  full  dose 

7J     « 

1  drachm 

"       "     3       « 

ft 

10     " 

80  minims 

f(              (I          £              « 

I 

15     " 

2  drachms 

Between  4  &  7  yrs.  old 

I 

20     " 

160  minims 

7  &  14       " 

I 

30     " 

\  fluid  oz. 

14&20       " 

§ 

40     " 

5  drs.  20  ms. 

Above  21  years  old 

Full  dose 

Drachms  and  Ounces. — All  through  this  book,  prescrip- 
tions for  medicine  will  be  found  written  in  drachms  and 
ounces.  When  referring  to  a  liquid  medicine  the  words 
drachm  and  ounce  really  mean  fluid  drachm  and  fluid 
ounce. 

There  are  60  grains  to  a  drachm,  8  drachms  to  an  ounce ; 
and  there  are  60  minims  to  a  fluid  drachm  and  8  fluid 
drachms  to  a  fluid  ounce.  A  minim  is  a  measured  drop. 
Now,  in  domestic  life,  these  measures  correspond  nearly  to 
certain  familiar  measures  as  follows : 

A  fluid  drachm  is  about  1  tea-spoonful. 
A  fluid  ounce  is  about  2  tablespoonfuls. 

A  tablespoon  holds  about    . .    half  a  (fluid)  ounce. 

A  dessertspoon  ' ' 

A  claret  glass     ' ' 

A  sherry  glass 


A  port  wine  glass 
A  tumbler          ' ' 


two  drachms, 
four  ounces, 
two  ounces, 
two  and  half  ounces. 
10  fluid  ounces,  or  half- 
a-pint. 


It  will  be  easily  understood  that  teaspoons  and  table- 
spoons and  glasses  vary  in  size,  so  that  they  are  not  ac- 
curate measures  for  medicines.  It  is  always  advisable  to 
have  a  properly  marked  medicine  glass  in  the  house  and 
to  measure  all  medicines  before  giving  them.  Most  modern 
teaspoons  will  hold  as  much  as  85  instead  of  only  60 
minims. 


88  DRINKING  CUP 

Dreams. — Dreaming  is  not  quite  a  healthy  condition. 
No  one  ought  to  dream,  pleasantly  or  otherwise.  Sleep, 
in  fact,  ought  to  be  quite  dreamless,  and  always  is,  if  we 
live  hygienically.  The  meaning  of  dreaming  is  this — 
only  a  part  of  the  brain  is  asleep ;  in  the  remainder  of 
it,  or  in  certain  parts  of  it,  thoughts  run  riot  uncontrolled 
by  the  higher  centers  of  judgment  and  reason.  Every 
mental  picture  seems  real;  probability  counts  for  nothing; 
nothing  is  too  absurd  and  nothing  seems  impossible,  in 
dreamland.  When  we  realize  the  necessary  truth  of  these 
facts  we  see  how  ignorant  and  absurd  it  is  to  be  influenced 
or  terrified  by  dreams,  in  our  waking  moments.  A  dream 
is  an  uncontrolled  fanciful  riot  of  the  lower  mental  facul- 
ties, and  the  causes  of  this  too-light  sleep  may  be  too  much 
mental  worry,  the  bad  habit  of  "thinking  things  out"  in 
bed,  too  heavy  bed  clothing,  excessive  blood  supply  to  the 
brain  due  to  heart  disease,  excessive  use  of  tobacco,  which 
depresses  the  heart,  tight-lacing,  costiveness  of  the  bowels, 
indigestion,  and  so  on.  The  treatment  of  dreaming  is  the 
removal,  as  far  as  possible,  of  the  cause,  and  not  the  taking 
of  composing  draughts  or  ' ' night  caps. ' '  (See  also  ' ' Night- 
mare.") 

Many  young  men  find  that  they  are  troubled  with 
dreams  only  when  they  sleep  on  the  back.  Such  should 
tie  an  empty  cotton  reel  on  the  back  over  the  spine  by 
a  string  round  the  waist,  so  that  it  will  wake  them  and 
make  them  turn  to  sleep  on  the  side.  Dreamers  should 
also  avoid  cigarette  smoking  and  late  suppers,  and  es- 
pecially alcoholic  drinks  in  the  evening. 

Drinking  Cup. — Reliable  bacteriologists  who  have  made 
examinations  of  common  drinking  cups  have  found  on 
them  the  germs  of  diphtheria,  tuberculosis,  syphilis,  in- 
fluenza, meningitis,  pneumonia  and  ordinary  colds. 

It  is  now  known  that  infantile  paralysis,  measles  and 
scarlet  fever  can  also  be  spread  in  this  way,  although  the 
germs  of  these  diseases  are  so  small  they  never  have  been 
seen. 

When  a  public  drinking  cup  has  been  used  by  hun- 
dreds of  people  it  is  not  only  probable  that  the  germs 
of  one  or  more  of  these  diseases  remain  on  the  cup,  but 
an  absolute  certainty. 

For  this  reason  the  use  of  the  common  drinking  cup  in 
public  places  is  being  rapidly  abolished  by  law. 


DROWNING  89 

In  its  place  one  of  two  devices  may  be  used: —  The 
bubble  fountain  without  a  cup;  or  the  individual  cup 
which,  as  a  folding  pocket  cup,  may  be  carried  about,  or 
the  paper  cup  which,  after  having  once  been  used,  can  be 
thrown  away  or  destroyed. 

Dropsy. — This  is  not  a  disease  but  a  symptom  of  many 
different  diseases.  There  are  several  different  kinds  of 
dropsy,  too,  though  the  word  is  generally  used  by  the 
public  to  refer  only  to  swollen  legs  or  to  fluid  in  the  ab- 
domen. Dropsy  is  a  collection  of  liquid  somewhere  in  the 
body  as  the  result  of  a  disease.  Thus  when  there  is  dropsy 
everywhere  under  the  skin,  it  is  called  anasarca.  The  skin 
is  swollen  and  doughy  to  the  feel.  If  you  press  your  finger 
into  it,  a  dimple  remains,  which  takes  a  certain  time  to 
disappear.  This  sign  is  called  by  doctors  ''pitting  on 
pressure. ' '  You  can  see  anasarca  round  the  ankles  at  bed- 
time, in  persons  who  have  anaemia,  or  heart  disease,  or 
merely  a  fatty  weak  heart,  or  Bright 's  disease.  In  the 
morning,  after  a  rest,  the  swelling  is  gone.  Dropsy  of  the 
belly  is  called  ascites.  The  fluid  collects  there  as  a  result 
of  some  disease  of  the  liver  or  gall  bladder. 

Dropsy  of  the  chest  is  called  hydrothorax,  and  occurs 
in  heart  and  kidney  diseases.  Dropsy  of  the  head  or  brain 
is  called  hydrocephalus,  or  water  on  the  brain.  Very  local 
limited  dropsical  swelling,  such  as  occurs  near  poisoned 
wounds  or  injured  joints  or  ''black-eyes,"  is  called  cedema. 

Treatment. — You  have  to  treat  the  disease  which  caused 
the  dropsy,  and  that,  of  course,  requires  the  skill  of  a 
doctor. 

But  you  have  also  to  deal  with  the  dropsical  part. 
JEdema  of  the  legs,  for  instance,  must  be  treated  by  rest- 
ing the  leg  in  a  horizontal  position.  In  some  cases  the  fluid 
has  to  be  drawn  off,  or  tapped,  by  the  doctor,  before  relief 
can  be  obtained. 

Drowning. — If  any  one  of  our  readers  should  rescue  a  man 
from  death  by  drowning,  or  should  come  across  a  person 
who  is  lying,  apparently  drowned  and  dead,  on  the  shore 
or  bank  of  a  river,  let  him  send  at  once  for  a  doctor,  but 
while  the  messenger  is  gone,  there  are  many  things  that 
he  can  do. 

In  drowning  death  may  be  caused  by  suffocation,  or  by 
the  shock  produced  by  striking  the  head  on  a  rock  or  on 
the  bottom  of  the  pond.  The  appearance  of  the  patient 


90  DROWNING 

will  vary  accordingly.  A  person  who  has  been  suffocated 
by  the  water  will  be  ' '  black  in  the  face, ' '  the  veins  of  neck 
and  arms  will  be  swollen;  and  the  heart  beats  cannot  be 
felt.  In  death  from  shock  the  skin  is  pale,  the  face  calm, 
and  no  water  has  been  sucked  into  the  lungs  because  no 
attempt  at  breathing  has  taken  place.  If  the  face  and 
mouth  of  a  drowning  person  have  been  under  the  water 
two  minutes  or  more,  there  is  probably  no  chance  of  his 
being  brought  back  to  life.  In  the  struggles  of  a  drown- 
ing man  he  draws  water  into  his  lungs  and  this  water  suf- 
focates him.  Now,  there  are  four  possible  ways  of  deal- 
ing with  a  person  who  is  apparently  drowned.  They  all 
aim  at  "artificial  respiration."  The  written  descriptions 
of  these  methods  are  of  little  use,  however,  in  our  opinion. 
They  can  be  learnt  only  in  practical  ambulance  classes 
where  "first-aid"  is  taught.  We  shall,  therefore,  give  only 
a  sketch  of  treatment,  so  that  while  the  messenger  is  gone 
for  the  doctor  the  man  on  the  spot  need  not  be  wasting 
valuable  time. 

(1)  Turn  the  body  on  its  face,  with  a  rolled-up  jacket 
under  the  chest,  and  kneel  on  or  press  the  chest  with 
the  hands  to  force  out  water  from  the  lungs.     Open  the 
mouth  and  put  the  finger  in  to  hook  out  any  mud  or 
weeds    that    may   block   up   the    throat.     Pull   out   the 
tongue  by  grasping  it  with  a  handkerchief,  so  that  it 
cannot  fall  back  and  stop  up  the  entrance  to  the  wind- 
pipe.    Loosen  all  tight  clothing. 

(2)  Then  put  the  body  on  its  back,  with  the  roll  under 
the  shoulder  blades,  and  try  to  make  the  patient  begin 
breathing  again.     This  requires  much  patience  and  pres- 
ence  of  mind;   above  all,   don't  hurry.     A  person   can 
only  breathe  about  15  times  in  a  minute,  that  is  once 
every  four  seconds.     If  you  hurry,  you  do  no  good.     Be 
deliberate  and  steady  and  firm. 

(3)  Kneel   down   at   the  top   of  the   patient's   head. 
Lean  over  him  and  seize  his  arms  just  above  the  el- 
bows.    Draw  the  arm  slowly  and  steadily  upwards  until 
you  make  them  meet  over  the  head.     (This  imitates  the 
first  act  of  taking  a  breath,  raising  the  ribs,  and  suck- 
ing air  into  the  lungs.)     Keep  the  arms  up  while  you 
count  "one  two  three"  and  then  turn  them  down  again 
pressing  them  firmly  and  gently  against  the  sides  of  the 


DUST  91 

chest  while  you  count  three.     (This  imitates  the  act  of 
expiration,  forcing  the  air  out  of  the  lungs  again.) 

Then  repeat  the  process,  slowly,  deliberately,  and 
firmly,  until  you  see  that  the  patient  is  beginning  to 
breathe  for  himself. 

(4)  Then  turn  your  attention  to  warming  him.     If 
there  is  someone  there  to  help  you,  let  him  attend  to 
that  part  of  the  business  while  you  are  doing  the  '  *  arti- 
ficial respiration."     If  blankets  are  obtainable,  wrap  the 
patient  up  in  them  and  commence  rubbing  the  limbs  up- 
wards in  the  most  energetic  way.     Take  the  boots  and 
stockings  off  and  chafe  the  feet,  if  you  have  no  hot-water 
bottle. 

(5)  As  soon  as  you  can  get  the  now  recovering  man 
into  a  house  or  room,  put  hot  bottles  or  hot  bricks  to 
the  abdomen,  feet,  under  the  armpits  and  between  the 
thighs.     As  soon  as  the  patient  begins  to  swallow  his 
saliva,  make  him  swallow  warm  brandy  and  water,  hot 
coffee,  or  mulled  wine. 

Note. — Artificial  respiration  must  be  persevered  with 
for  at  least  an  hour,  even  in  apparently  hopeless  cases. 

Once  recovered  and  really  alive,  if  the  patient  seems 
to  want  to  sleep,  let  him.  It  will  aid  his  recovery  very 
much. 

Dust. — The  subject  of  dust  became  of  the  greatest  im- 
portance to  us  when  we  came  to  realize  what  a  vast  amount 
of  disease  was  directly  attributable  to  it.  For  example 
in  some  of  the  dusty  trades — such  as  grinders,  49%  of 
all  the  deaths  occur  from  consumption — largely  caused  by 
inhaled  dust. 

For  our  purposes  consideration  of  the  subject  of  dust 
is  best  divided  into  inert  and  living  dust  (bacteria)  ;  and 
in  reference  to  its  location,  into  that  in  the  street,  the 
home,  the  workshop  and  the  public  building  or  convey- 
ance. 

Inert  dust  is  chiefly  dangerous  on  account  of  its  irri- 
tating character  to  the  lungs, — causing  an  increased 
vulnerability  to  tuberculosis  and  other  germ  diseases.  In 
New  York  City  305  tons  of  iron  and  steel  dust  are  pro- 
duced monthly. 

Dangerous  disease  germs  may  be  the  sole  constituent  of 
finer  dust  or  they  may  cling  to  the  coarser  inert  particles. 


92  DUST 

This  is  the  reason  why  exposure  to  dust  on  streets  so  often 
produces  colds,  catarrh,  influenza,  hay  fever,  tonsilitis, 
pneumonia  and  tuberculosis. 

Solid  dust  particles  and  bacteria  which  we  breathe  in 
the  air  do  not  come  out  with  the  expired  air,  but  are  re- 
tained on  the  moist  surfaces  of  the  mucous  membranes  of 
the  respiratory  tract.  The  body  ultimately  finds  a  way  to 
dispose  of  much  of  this,  but  in  this  process  it  is  liable  to 
sustain  much  harm. 

Dust  particles  on  the  street  come  largely  from  small 
fragments  of  sand,  broken  fibers  of  plants,  pollen,  fine  hairs, 
the  pulverized  excreta  of  domestic  animals,  ashes,  fibers  of 
clothing  and  other  fabrics,  particles  of  lime  or  plaster  or 
soot,  masses  and  clusters  of  micro-organisms. 

So  dirty  is  the  air  of  the  New  York  street  that  while  in 
a  given  quantity  of  air  there  were  only  34  bacteria  in  a 
private  house,  on  the  street  there  were  5,810. 

For  the  removal  of  this  street  dust  we  are  in  the  hands 
of  the  city  street-cleaning  department.  (Heaven  help  us.) 
All  we  as  individuals  can  do  is  to  breathe  through  our  noses 
and  our  handkerchiefs  and  put  our  trust  in  the  Lord  and 
our  ballots  in  the  box  for  the  other  political  party  at  the 
next  election. 

Home  dust  may  be  diminished  by  filtering  all  incoming 
air  through  cheese  cloth  (if  there  is  a  proper  ventilating 
system),  and  by  controlling  the  expectoration  of  invalids. 

To  avoid  the  collection  of  dust  have  hard  floors,  with 
rugs  which  may  be  cleaned  out  of  doors,  few  hangings, 
and  furniture  upholstered  with  smooth  surfaced  fabrics. 

It  must  be  remembered  that  when  air  enters  a  room  the 
germs  on  dust  settle. 

The  air  passes  out  of  the  room  purer  but  the  germs  remain 
and  keep  constantly  collecting  in  larger  numbers. 

In  cleaning,  anything  which  stirs  up  this  dust  is  un- 
desirable. (See  Cleaning.)  The  best  methods  are  the  use 
of  the  vacuum  cleaner  and  the  moist  cloth, — avoiding  the 
feather  duster  and  the  dry  broom. 

In  the  workshop  the  dust  most  to  be  feared  is  that 
which  is  produced  in  the  course  of  manufacture.  The 
dusty  trades  produce  the  greatest  mortality  from  consump- 
tion. The  remedy  is  to  have  the  dust  removed  at  its  point 
of  origin  by  a  suction  ventilator. 

In  factories  and  public  places  dust  should  be  filtered  out 


EAR  DISEASES  93 

of  the  air  employed  for  ventilation.  Special  precautions 
should  be  taken  against  the  scattering  of  bacterial  dust 
from  people  by  discouraging  unprotected  sneezing,  cough- 
ing and  spitting. 

Floors  and  furnishings  should  be  such  as  to  gather  as 
little  dust  as  possible.  Cleaning  should  be  frequently  done 
(at  such  times  as  when  the  dust  has  well  settled)  by  means 
of  vacuum  cleaners,  moist  cloths,  etc.  (See  Cleaning.) 

Sunlight  is  one  of  the  best  agencies  to  take  the  sting  out 
of  living  (bacterial)  dust. 

Dyspepsia  (see  Indigestion). 

Ear  Diseases. — Doctors  speak  of  the  " external  ear," 
which  is  the  ear  you  see  at  each  side  of  a  person's  head, 
the  "middle  ear,"  which  is  inside  the  head  and  consists 
of  the  delicate  machinery  of  the  hearing  apparatus,  and 
of  the  "internal  ear,"  which  is  the  auditory  (or  hearing) 
nerve.  The  commonest  disease  of  the  external  ear  is 
eczema,  which  generally  requires  only  very  slight  treat- 
ment (see  "Eczema"). 

Of  the  hearing  apparatus  inside  the  head  the  only  dis- 
eases we  need  mention  here  are  polypus  and  catarrh.  The 
former  requires  the  skill  of  an  aural  surgeon  for  its  re- 
moval. 

Catarrh  of  the  middle  ear  is  very  common.  When  acute, 
it  is  a  part  of  a  bad  cold  in  the  head,  which  has  affected 
the  ear  as  well  as  the  nose  and  throat.  The  ear-ache  is 
intense,  because  behind  the  drum  of  the  ear  there  is  a  little 
collection  of  matter  which  cannot  get  out.  If  the  ear- 
ache is  treated  by  poulticing,  the  matter  bursts  through 
the  ear-drum,  and  comes  out,  and  the  relief  is  immediate. 
Afterwards  the  little  hole  in  the  ear-drum  heals  up  and 
the  hearing  may  then  be  as  good  as  ever.  Do  not  poke 
anything  into  the  ear,  or  you  may  injure  the  drum.  In  a 
very  severe  case  of  ear-ache  it  is  better  to  call  the  doctor. 
He  will  very  likely  order  leeches  to  be  put  on  over  the 
skin  at  the  back  of  the  ear,  and  bleeding  should  be  en- 
couraged. Then  with  a  fine-pointed  delicate  knife,  he  will 
just  prick  the  ear-drum,  and  let  the  matter  out.  If  the 
matter  is  allowed  to  break  through  the  ear-drum  by  itself 
there  is  a  risk  that  the  little  hole  or  "perforation,"  will  not 
heal  and  that  the  catarrh  will  become  chronic. 

Chronic  catarrh  of  the  ear  is  very  difficult  to  get  rid  of. 
When  any  ear  discharge  appears,  go  to  an  ear  surgeon  at 


94  ECZEMA 

once.  Constant  syringing  may  be  tried,  using  a  Higgin- 
son  syringe  and  warm  boric  acid  solution.  If  the  dis- 
charge smells  badly,  drops  of  this  lotion  may  be  put  into 
the  ear  at  bedtime: — Sulphate  of  zinc  and  carbolic  acid, 
of  each,  5  grains,  and  distilled  water,  one  ounce.  Much 
ill-smelling  discharge  may  mean  that  there  is  a  polypus 
there.  But  all  such  means  often  fail  to  cure,  and  syring- 
ing does  not  reach  the  seat  of  the  trouble.  Wearing  cotten- 
wool  in  the  ears  only  pens  up  the  foul  discharge. 

Some  wax  in  the  ear  is  quite  natural,  but  when  there  is 
too  much  of  it  the  patient  gets  noises  and  singing  in  the 
ears,  deafness  and  sometimes  giddiness.  Gentle  syringing 
with  warm  water  is  enough  to  dislodge  the  wax,  but  if  this 
is  unsuccessful,  go  to  a  doctor  about  it  without  delay.  (See 
also  "Deafness.") 

Eczema. — Eczema  is  one  of  the  commonest  of  all  skin 
diseases  and  the  name  has  been  used  so  loosely  that  there 
is  the  utmost  confusion  in  the  public  mind  as  to  what  is 
eczema  and  what  is  not,  and  as  to  what  is  "good  for 
eczema ' '  and  what  is  not.  It  is  a  disease  which  has  several 
different  stages  and  which  requires  different  treatment  in 
each  stage.  It  is  a  disease  in  which  the  three  stages  may 
be  present  at  one  and  the  same  time,  in  the  same  person. 
The  different  stages  can  only  be  properly  recognized  by 
a  doctor,  and  the  right  treatment  can  only  be  applied  by  a 
doctor.  Not  only  that,  but  there  are  many  cases  of  eczema 
which  are  incurable.  All  things  considered,  therefore,  the 
layman  who  is  going  to  treat  eczema  on  his  own  respon- 
sibility and  knowledge  has  a  hard  task  before  him ;  and  the 
person  who  goes  about  asking  his  friends  or  consulting  the 
newspapers  for  a  "certain  cure"  is  doomed  to  disappoint- 
ment, because  there  is  no  such  thing  as  a  "certain  cure" 
for  eczema. 

However,  a  little  elementary  knowledge  of  the  disease 
will  greatly  help  the  intelligent  reader  and  patient  to  give 
intelligent  assistance  to  the  doctor  in  his  difficult  task,  so 
that  we  have  decided  to  give  a  short  account  of  this  disease 
and  its  treatment,  and  a  few  medical  recipes. 

Eczema  is  a  catarrh  of  the  skin  just  as  a  cold  in  the  head 
is  a  catarrh  of  the  mucous  lining  of  the  nose  and  throat. 
And  just  as  the  nose  "runs"  with  fluid  discharge  and  has 
scabs  when  the  cold  is  "drying  up,"  so  does  the  skin  dis- 
charge and  scab  over  in  eczema.  This  more  or  less  con- 


ECZEMA  95 

tinual  "weeping"  of  the  skin  under  the  dried  scabs  is 
characteristic  of  eczema. 

Eczema  seems  to  arise  spontaneously,  and  instead  of  run- 
ning a  course,  it  smoulders  on,  sometimes  better,  sometimes 
worse.  There  are  very  many  varieties  of  eczema,  but  really 
they  are  all  different  stages  of  the  same  process,  though 
no  two  cases  of  eczema  are  exactly  alike. 

An  attack  of  eczema  generally  begins  with  sensations  of 
burning  and  itching;  then  the  part  gets  covered  with  a 
more  or  less  deep  red  blush,  then  little  blebs  form  on  it 
and  you  see  all  the  signs  of  the  catarrh  of  the  skin — swell- 
ing, heat,  redness,  and  pain.  Then  the  blebs  burst  or  are 
torn  open  by  the  patient's  scratching,  and  the  skin  "weeps" 
a  fluid  which  stiffens  linen  as  if  it  were  starch.  After  a 
few  days  the  patches  dry  up  and  heal,  and  then  probably 
another  patch  or  two  breaks  out,  until  they  may  spread 
all  over  the  body. 

We  have  described  a  mild  case.  In  worse  cases  the  skin 
may  become  thickened  and  inflamed  and  cracked  terribly; 
the  itching  may  cause  weeks  of  sleeplessness  and  ill-health. 
We  have  seen  strong  men  crying  with  worry  and  irrita- 
tion and  want  of  sleep  when  the  eczema  did  not  look  very 
bad;  and  we  have  seen  them  scratch  madly  at  the  itching 
skin  until  blood  came,  and  until  they  became  tired  out  with 
pain  and  nervous  exhaustion,  and  sink  to  sleep  for  a  while. 
Added  to  such  terrors  as  these,  there  are  sometimes  extra 
sores  and  boils  produced  by  scratching  and  contact  with 
infected  things.  No  wonder  then  that  the  doctor  sometimes 
feels  in  despair  about  a  case  of  eczema. 

There  is  no  part  of  the  skin  which  may  not  be  attacked 
by  eczema.  We  shall  refer  especially  only  to  a  few  of  the 
commoner  varieties  of  the  disease. 

Scalp  eczema  is  generally  red  and  dry  and  covered  with 
crusts,  and  complicated  with  other  kinds  of  skin  disease. 
Wash  head  with  soft  soap  and  apply  weak  sulphur  oint- 
ment. 

Eczema  of  the  ear  is  common  and  sometimes  spreads  right 
into  the  ear  hole.  Cold  cream  should  be  applied.  The 
druggist  can  sell  you  some  cheaper  than  you  can  make  it. 

Eczema  of  the  palms  leads  to  much  cracking  and  swelling 
and  pain  and  soreness  of  the  hands ;  the  nails  often  become 
pitted  and  split  and  discolored.  Soak  the  hands  in  a 
calamine  lotion  bath  for  a  half-hour  occasionally.  Keep 


96  ECZEMA 

the  parts  always  covered  with  weak  sulphur  ointment 
spread  on  lint. 

Eczema  of  the  bathing-drawers  area. — This  name  ex- 
plains itself.  The  eruption  is  confined  to  the  parts  which 
would  be  covered  by  short  bathing-drawers.  The  crusts 
and  swollen  inflamed  skin,  so  tender  that  the  patient  can 
hardly  sit  down,  make  life  almost  unbearable.  The  parts 
should  be  swathed  in  linen,  soaked  in  calamine  lotion,  and 
later  on  dredged  lightly  with  a  powder  made  up  of  talc, 
87  parts ;  starch,  10  parts ;  and  salicylic  acid,  3  parts. 

Eczema  is  sometimes  associated  with  piles,  which  must 
be  treated  by  themselves  (see  ''Piles"). 

Now,  the  causes  of  eczema  are  not  well  understood.  Cer- 
tain types  of  people,  such  as  gouty  people,  are  very  liable 
to  it;  but  there  is  no  real  gouty  eczema,  and  in  Germany, 
where  there  is  very  little  gout,  there  is  plenty  of  eczema. 
The  disease  is  just  as  common  among  the  well-fed  chil- 
dren of  the  rich  as  among  those  of  the  poor.  Breast-fed 
children  are  not  less  liable  to  it  than  bottle-fed. 

Eczema  itself  is  not  contagions.  It  can  nearly  always 
be  cured  if  a  proper  kind  of  treatment  is  adopted,  and 
stuck  to  perseveringly  for  a  long  time;  but  the  home- 
physicker  has  little  or  no  chance  of  curing  it  with  house- 
hold remedies. 

Treatment  of  eczema. — We  know  that  there  are  certain 
individuals  who  believe  that  in  every  case  of  disease,  es- 
pecially skin  disease,  the  "blood  must  be  out  of  order," 
therefore,  they  argue,  you  must  give  a  medicine  to  * '  purify 
the  blood";  and  the  disease  will  cure  itself  then.  Well, 
there  is  a  certain  small  amount  of  truth  in  the  idea,  and 
it  is  worthy  of  a  little  of  our  consideration.  A  few  cases 
of  eczema  may  be  improved  by  blood-purifying  medicines, 
but  in  most  cases  the  less  drugging  the  better.  No  known 
medicine  will  benefit  every  acute  case  of  eczema.  Arsenic 
and  antimony  and  opium  are  all  useful  in  acute  and  pain- 
ful cases,  but  these  medicines  being  also  poison  must  be 
prescribed  by  the  doctor  himself.  The  following  items  of 
treatment  can  be  attended  to  by  the  patient  himself: — 
A  very  simple  diet,  a  free  action  of  the  bowels  (castor 
oil),  no  stimulants,  rest  in  bed  with  light  coverings,  and 
two-grain  doses  of  quinine  every  four  hours.  This  is  the 
way  to  treat  an  acute  inflamed  attack  of  eczema.  The  doc- 
tor will  add  the  other  necessary  medicines. 


ECZEMA  97 

Now  the  local  treatment  of  eczema  is  much  more  im- 
portant. In  applying  local  ointments  and  remedies,  you 
must  keep  two  rules: 

i- 

(1)  The  strength  of  the  remedy  must  be  in  propor- 
tion to  the  degree  of  intensity  of  the  disease.     It 
is  hopeless  to  apply  a  strong  ointment  to  a  mild 
attack  of  eczema. 

(2)  The  remedies  must  be  kept  continuously  applied. 
It  is  useless  to  smear  a  little  ointment  on  occa- 
sionally. 

Then,  as  regards  the  treatment  itself: — 

Remove  all  crusts  and  scales,  after  softening  them 
with  olive  oil,  with  a  piece  of  clean  lint.  Other- 
wise the  remedies  cannot  get  down  to  the  mis- 
chief. The  parts  must  never  be  washed  with 
ordinary  water,  and  soap  must  never  go  near 
the  disease.  The  weeping  surfaces  may  then  be 
bathed  with  a  lotion  made  of  a  soloid  of  boric  acid 
dissolved  in  rain  water,  or  water  which  has  been 
boiled,  and  dried  by  the  use  of  muslin  bags,  con- 
taining starch  and  boric  acid  powder  in  equal 
parts.  Then  smear  some  of  this  cold  cream  on 
a  clean  rag  and  keep  it  applied  to  the  raw  sur- 
faces:— Zinc  oxide  powder,  6  drachms;  lanolin 
ointment,  2  drachms ;  olive  oil,  1  ounce ;  lime  water, 
1  ounce. 

As  to  other  ointments  and  preparations,  you  have  to 
"feel  your  way"  in  using  them.  The  plastermulls  in- 
vented by  Professor  Unna  are  most  useful  to  eczema  pa- 
tients. They  are  to  be  cut  out  to  the  exact  size  of  the  patch 
of  eczema.  They  are  made  of  various  medicinal  materials. 
For  the  terrible  itching,  dab  on  the  following  lotion  with  a 
clean  plug  of  cotton-wool: — Carbolic  acid,  1  drachm; 
glycerin,  2  drachms;  water,  to  8  ounces.  If  that  does  not 
relieve  the  itching,  perhaps  the  following  will  be  better: — 
Lunar  caustic,  15  grains;  sweet  spirit  of  niter,  1  ounce; 
detergent  tar  solution,  2  ounces.  To  be  dabbed  on  with 
cotton-wool  (never  with  a  sponge). 

For  the  old  hard  chronic  patches  of  eczema,  which  will 
not  heal  or  yield  at  all  to  other  plastermulls  or  ointments, 


98  ENEMA 

try  sulphur  plastermull ;  and  lastly  the  following: — 
Chrysarobin,  10  grains;  lanolin,  1  ounce. 

Lastly,  do  not  forget  that  eczema  is  a  catarrh  of  the  skin, 
and  so  the  dryer  the  climate  the  better  will  the  patient 
get  on. 

Emetics. — An  emetic  is  a  medicine  which  causes  vomit- 
ing. Here  is  a  list  of  those  most  commonly  in  use : — 

(1)  Give  30  grains  (about  half  a  small  teaspoonful) 
of  sulphate  of  zinc  in  a  tumblerful  of  tepid  water. 

(2)  Or,  give  10  grains  of  sulphate  of  copper  dis- 
solved in  warm  water. 

(3)  Or,  give  a  dessertspoonful  of  mustard  stirred 
up  in  a  tumblerful  of  warm  water. 

(4)  Or,  copious  draughts  of  warmed  sea  water. 

(5)  To  produce  vomiting  in   cases   of  bad  cough, 
with  sticky  phlegm,  which  cannot  be  got  rid  of  and 
makes  the  patient  retch: — Give    (to  a  child)    a  tea- 
spoonful,  and  (to  an  adult)  a  tablespoonful  or  more, 
of  ipecacuanha  wine. 

(6)  When  the  heart  is  feeble  and  an  emetic  is  neces- 
sary, a  tablespoonful  of  sal  volatile  in  a  tumbler  of 
water  may  be  very  useful. 

(7)  If  far  from  medical  aid  tickle  the  throat  with 
a  feather. 

Emetics  are  given  (1)  to  children,  especially  those  with 
whooping  cough,  to  help  them  to  get  rid  of  the  phlegm; 
(2)  to  drunkards  who  have  "mixed  drinks,"  and  are  be- 
ing poisoned  with  alcohol;  (3)  to  persons  who  have  taken 
poison. 

(8)  The   stomach   pump.     The   proper  use   of   the 
regular  stomach  pump  cannot  be  taught  here.     But  in 
the  absence  of  a  doctor,  a  child  who  has  taken  poison, 
or  who  has  been  fed  upon  poisoned  food,  may  have 
his  stomach   emptied  through  an  india  rubber  male 
catheter  attached  to   an   ordinary  glass   ear  syringe. 
Eub  the  catheter  with  a  little  oil  before  you  slip  it 
down  the  child's  throat. 

Enema. — A  doctor  will  sometimes  tell  you  to  administer 
an  enema  in  his  absence.  An  enema  is  an  injection  made 
with  an  india  rubber  syringe  into  the  back  passage.  An 


EPILEPSY  99 

enema  is  generally  given  for  the  purpose  of  making  the 
bowels  act  freely;  but  it  may  be  given  for  other  pur- 
poses, such  as  to  apply  a  lotion  to  a  sore  or  ulcerated 
surface  in  the  rectum,  such  as  occurs  in  dysentery;  or  to 
nourish  the  patient  when  he  cannot  take  food  by  the  mouth, 
because  of  a  cancer  for  instance;  or  to  stop  diarrhea.  An 
enema  for  making  the  bowels  act  is  made  of  a  pint  of  warm 
water  and  soapsuds.  Another  excellent  way  of  making  the 
bowels  act  is  to  use  a  little  enema  syringe  made  of  vulcanite, 
and  inject  about  two  teaspoonfuls  of  glycerine.  The  com- 
mon form  of  syringe  used  for  ordinary  enemas  is  called  a 
"Higginson  syringe."  The  patient  ought  to  lie  on  his  or 
her  left  side,  with  a  towel  or  mackintosh  beneath  him  to 
catch  any  drippings.  The  bone  nozzle  then,  well  oiled, 
should  follow  a  well-oiled  forefinger  into  the  bowel,  and  be 
pushed  upwards  for  one  inch.  Then  withdraw  the  finger 
and  push  the  nozzle  backwards  and  upwards  for  another 
inch  and  a  half.  Then  use  the  ball  of  the  syringe.  Many 
patients  like  to  put  in  the  nozzle  for  themselves.  It  gives 
no  pain,  and  relief  of  the  bowels  is  speedy. 

Epilepsy. —  (I.)  In  olden  times  this  disease  used  to  be 
called  the  Falling  Sickness,  because  it  consists  of  a  series 
of  sudden  fits  in  which  the  sufferer  almost  always  falls 
down,  wherever  he  may  be.  A  fit  of  epilepsy  must  not  be 
confused  with  other  attacks,  such  as  syncope  or  fainting, 
nor  with  apoplexy,  also  called  a  fit.  An  epileptic  fit  or 
attack  consists  of  a  sudden  loss  of  power  and  sense,  causing 
a  fall  down,  and  convulsive  twitchings  of  the  muscles  of 
the  arms  and  legs,  of  the  face  and  jaws.  Every  fit  of  con- 
vulsions is  not  epilepsy,  for  children  are  liable  to  have  fits 
from  teething,  from  indigestion,  or  when  sickening  for 
some  fever  or  inflammation ;  they  also  have  fits  from  spasms 
in  the  throat  and  windpipe.  Any  severe  attack  of  convul- 
sions occurring  in  a  previously  healthy  child,  man,  or 
woman,  may  be  of  epileptic  origin,  but  no  one  could  be  sure 
of  this.  This  disease  varies  very  much  in  severity,  both 
as  to  the  frequency  of  the  attacks,  and  as  to  the  importance 
of  each  fit.  Some  sufferers  have  several  fits  in  a  day,  others 
may  have  only  one  fit  in  a  month  or  in  a  year.  A  fit  may 
come  on  suddenly,  and  last  only  a  moment,  or  it  may  cause 
a  sudden  fall,  deep  insensibility,  general  convulsions, 
gnashing  of  the  teeth,  biting  of  the  tongue,  and  foam  at 
the  mouth,  and  may  last  for  hours.  Severe  fits  are  fol- 


100  EPILEPSY 

lowed  generally  by  heavy  sleep  and  then  by  headache  and 
exhaustion.  In  some  exceptional  cases  the  patient  has 
some  warning  of  the  coming  fit,  but  in  most  persons  the 
attack  is  immediate,  and  the  sufferer  drops  whatever  he 
may  be  holding,  and  falls  without  any  power  to  save 
himself  from  injury  or  from  death.  Epileptics  are  often 
burnt,  drowned,  and  suffocated  in  accidental  manners ; 
therefore,  never  leave  an  epileptic  alone  after  a  fit  has 
occurred.  The  great  mystery  about  the  disease  is  that 
although  from  the  symptoms  we  know  that  the  brain  and 
spinal  cord  must  be  affected,  yet  after  death  sometimes  no 
fault  can  be  found  in  them ;  and  at  other  times  faults  are 
seen  which  may  or  may  not  account  for  the  fits  during  life. 
Sometimes  surgeons  discover  neither  brain  injury,  nor 
tumor,  nor  bleeding,  nor  abscess.  When  there  have  been 
several  epileptic  fits  the  disease  is  rarely  cured,  or  recov- 
ered from.  Slight  fits  often  lead  to  more  serious  mind 
failure  than  severe  convulsions,  and  often  end  in  madness. 
Epileptics  should  not  marry,  nor  have  families,  for  their 
disease  is  very  apt  to  reappear  in  their  offspring. 

(II.)  What  to  do  with  epileptics  is  a  very  difficult  prob- 
lem, for  being  never  safe  from  attacks  of  the  disease  they 
are  dangerous  to  have  as  servants  in  private  houses,  and 
are  not  safe  as  workers  in  factories,  nor  in  the  Army  or 
Navy.  Farm  colonies  have  been  instituted,  and  perhaps 
such  sufferers  are  more  safe  in  the  fields  than  anywhere  else. 

Epileptics  have  often  bad  tempers,  and  are  passionate 
and  revengeful,  while  many  are  almost  imbecile.  A  con- 
siderable number  of  murders  are  done  every  year  by  epi- 
leptics, after  recovering  from  a  seizure,  their  mad  violence 
being  a  sudden  short  outbreak,  which  soon  passes  off,  and 
may  leave  them  quiet  and  reasonable,  and  sometimes  quite 
forgetful  and  unconscious  of  what  they  have  done.  Hered- 
ity seems  to  be  the  most  frequent  origin  of  this  ailment, 
and  the  next  most  frequent  cause  is  intemperance  or  mad- 
ness in  the  parent.  True  epilepsy  is  not  started  by  in- 
juries, nor  by  the  drunken  habits  of  the  person  himself. 
When  anyone  has  had  a  series  of  fits,  he  or  she  rarely  loses 
them  entirely,  however  treated  by  medicines,  food,  or  diet. 
Almost  every  known  drug,  vegetable,  mineral,  or  animal, 
has  been  given  for  this  disease,  and  more  than  a  hundred 
have  at  some  time  or  other  gained  some  reputation  as  cura- 
tives; but  it  is  sad  to  have  to  say  that  there  is  but  one 


EPILEPSY  101 

which  produces  any  definite  improvement  by  making  the 
fits  less  severe,  and  the  intervals  between  them  of  longer 
duration.  This  drug  is  bromine,  which,  however,  cannot 
be  given  with  advantage  in  its  pure  state;  it  is  a  deep 
reddish-brown  pungent  liquid,  obtainable  from  seaweed. 
In  medicine  it  is  used  combined  with  alkalies,  and  its  most 
usual  preparations  are  bromide  of  potassium,  bromide  of 
sodium,  and  of  ammonium.  A  fourth  form  is  a  clear,  color- 
less, sour  liquid,  named  hydrobromic  acid.  Bromide  of 
potassium  has  been  most  used,  beginning  with  doses  of  five 
grains  for  adults,  and  afterwards  much  increased.  It  is  a 
drug  with  a  calmative  effect,  but  taken  continually  it  is 
very  depressing,  and  it  is  not  wise  to  take  it  except  under 
medical  care.  Arsenic  was  once  a  common  remedy,  and 
so  was  nitrate  of  silver ;  solutions  of  salts  of  gold  have  been 
tried,  and  now  disused.  Epilepsy  is  eminently  a  disease 
for  being  periodically  seen  by  a  doctor,  who  will  watch  the 
course  of  the  treatment,  and  decide  as  to  its  success. 

(III.)  As  to  the  treatment  of  these  fits  of  epilepsy,  apart 
from  medicines,  we  must  say  that  neither  a  purely  flesh 
nor  an  entirely  vegetable  diet  will  remove  the  tendency  to 
these  fits,  nor  will  total  abstinence.  The  use  of  tobacco 
does  not  seem  to  have  any  curative  effect,  nor  does  it  seem 
to  make  the  disease  any  worse.  Epileptic  fits  are  attacks 
of  convulsive  spasms  of  the  voluntary  muscles.  These 
muscles  are  governed  by  impulses  sent  from  the  brain  and 
spinal  cord  through  the  nerves,  and  these  spasmodic  jerk- 
ings  are  involuntary  in  onset,  and  cannot  at  all  be  checked 
by  the  strongest  effort  of  will.  In  severe  fits,  there  being 
temporary  loss  of  the  senses,  of  course  the  human  will  has 
no  chance  of  controlling  the  spasms.  The  disease  called 
hysteria,  which  occurs  chiefly  in  nervous  and  delicate  young 
women,  will  sometimes  give  rise  to  fits  which  imitate  an 
epileptic  seizure;  but  the  history  of  the  case,  and  the  fact 
that  there  is  an  absolute  insensibility,  serve  to  distinguish 
the  two  ailments.  An  epileptic  never  gives  more  than  one 
cry  in  a  fit  at  the  onset,  whereas  the  hysterical  girl  will 
keep  up  a  noisy  disturbance  of  mixed  crying,  screaming, 
and  often  laughter  of  a  mad  sort.  In  the  hysterical  fit 
also  the  tongue  is  not  bitten,  nor  is  there  foaming  at  the 
mouth.  The  actual  epileptic  fit  cannot  be  stopped  until  it 
has  run  its  course,  except  by  means  of  chloroform  or  ether, 
and  this  administration  would,  under  the  circumstances, 


102  ERYSIPELAS 

be  almost  as  dangerous  as  the  fit  itself.  The  most  impor- 
tant thing  to  be  done  for  a  fit  is  to  prevent  the  patient 
from  self-injury,  and  from  wounds  and  bruises  from  knock- 
ing himself  on  the  floor  or  against  furniture.  In  any  case 
where  there  is  gnashing  of  the  teeth,  it  is  a  good  plan  to 
put  a  firm,  but  soft  plug  of  cork,  or  some  similar  material 
between  the  jaws ;  otherwise  the  tongue  may  be  sadly  bitten. 
Persons  who  live  in  the  same  dwelling  with  an  epileptic 
should  run  to  his  assistance  when  any  cry  or  moan  is 
heard,  and  the  patient  should  be  laid,  if  possible,  on  the 
floor  on  a  rug;  or  if  put  on  a  bed  or  sofa,  he  must  be 
prevented  from  falling.  In  general,  no  medicine  can  be 
given  during  a  fit,  but  in  some  very  severe  and  long  attacks 
an  anaesthetic,  such  as  ether,  chloroform,  or  nitrous  gas, 
may  be  administered  by  a  doctor. 

Erysipelas. — This  disease  is  less  common  than  it  used  to 
be,  and  the  reason  is  that  our  sanitary  arrangements  are 
much  more  perfect  than  they  were. 

Where  there  are  defects  of  drainage,  broken  sewers,  cess- 
pits near  houses,  or  worse  still  near  wells,  or  where  sewer 
gas  enters  dwelling  houses,  there  erysipelas  used  to  be  rife. 
It  was  also  a  common  disease  in  the  surgical  wards  of  our 
hospitals  before  that  famous  surgeon,  Lord  Lister,  intro- 
duced the  antiseptic  mode  of  treating  wounds. 

Erysipelas  may  attack  patients  suffering  from  wounds,  or 
it  may  appear  in  a  person  who  is  otherwise  out  of  health, 
sickly,  or  of  broken-down  constitution.  In  either  case  the 
true  cause  appears  to  be  a  special  disease  germ  floating 
about  the  air  of  a  place.  It  used  to  be  called  a  miasmatic 
disorder,  and  by  miasm  was  meant  impure  air — air  poi- 
soned by  exhalations  from  diseased  persons,  or  from  many 
wounds,  or  from  decaying  animal  matter.  This  was  before 
the  time  when  the  microscope  became  powerful  enough  to 
discover  very  minute  bacilli,  bacteria,  and  microbes.  This 
disease  is  sometimes  epidemic — that  is,  affecting  a  great 
number  of  persons  at  once ;  or  it  may  be  sporadic — that  is 
to  say,  occurring  in  solitary  cases. 

Erysipelas  is  always  contagious,  and  although  medical 
men  and  nurses  but  rarely  catch  it  when  attending  cases, 
yet  sickly  people,  or  persons  with  open  wounds,  or  with 
ulcerated  throats,  often  take  the  disease. 

Erysipelas  is  an  inflammatory  fever  of  a  severe  type, 
associated  with  painful  redness  and  swelling  of  some  part 


EXERCISE  AND  RECREATION         103 

of  the  skin,  and  often  of  the  face  and  head.  The  affected 
skin  becomes  pink,  then  more  and  more  red,  and  livid  in 
tint;  it  is  puffy  and  tender,  and  the  patch  tends  to  spread. 
It  may  attack  the  edges  of  an  unhealthy  wound,  or  any 
old  ulcer.  The  first  symptoms  are  believed  to  appear  about 
six  days  after  taking  the  infection;  then  there  are  chilli- 
ness, shivering,  and  fever,  headache,  dryness  of  tongue, 
much  discomfort,  and  then  the  inflammation  is  found  com- 
ing out  on  some  patch  of  skin,  with  pain  and  redness.  If 
the  face  is  attacked,  the  swelling  may  be  so  great  that  the 
features  are  hidden.  Nausea,  vomiting,  and  diarrhea  are 
common.  Death  may  follow  from  exhaustion,  from  blood 
poisoning,  or  from  the  disease  attacking  the  windpipe,  or 
from  its  spreading  inward  to  the  brain. 

As  soon  as  the  disease  is  discovered,  the  patient  must  be 
put  to  bed  and  have  a  sharp  purgative,  and  should  have 
no  solid  food.  Some  doctors  apply  poultices  to  the  red 
patches,  while  others  prefer  only  dry  applications,  such  as 
starch,  flour,  or  rice  powder. 

The  perchloride  of  iron  is  generally  prescribed  by  the 
doctor  in  these  cases.  It  is  almost  a  "certain  cure."  Fif- 
teen-drop doses  of  the  liquor  are  taken  with  advantage  by 
some  adults.  French  surgeons  rub  in  a  lotion  of  per- 
chloride of  iron,  30  per  cent.,  with  a  lint  swab,  locally. 
But  most  cases  get  well  if  the  part  is  merely  covered  with 
a  mixture  of  equal  parts  of  boric  acid  and  flour,  and  the 
strength  of  the  patient  kept  up  with  iron  tonics  and  stimu- 
lants. 

Exercise  and  Recreation. — The  most  important  factors  in 
the  maintenance  of  health  are  the  avoidance  of  infection, — 
the  use  by  the  body  of  pure  fuel  (food,  drink,  and  air) 
— and  the  maintenance  by  the  body  of  a  high  degree  of 
resistance  to  disease.  Among  the  last  means  of  health 
preservation  few  are  more  important  than  exercise. 

The  main  effect  of  exercise  on  the  body  is  to  increase 
oxidation.  It  increases  the  rapidity  of  the  circulation 
everywhere  and  therefore  causes  in  all  organs  a  quicker 
renewal  of  plasma,  and  a  more  effective  removal  of  the 
waste  products  of  tissue  combustion. 

No  man  can  continue  healthy  without  exercise  in  some 
form.  Physical  health  requires  bodily  exercise.  Mental 
health  requires  recreation. 

Though,  as  is  the  case  with  food  and  drink,  some  people 


104         EXERCISE  AND  RECREATION 

require  more  exercise  than  others,  yet  the  complete  avoid- 
ance of  it  results  in  digestive  and  nervous  disturbances, 
loss  of  vigor,  and,  if  continued,  in  organic  degeneration  and 
disease. 

The  form  of  exercise  must  vary  with  the  habits,  time, 
strength,  means  and  requirements  of  the  individual. 

The  best  form  of  exercise  is  that  which  is  at  the  same 
time  recreation. 

This  is  especially  the  case  with  children.  Boys  must 
find  amusement  in  their  exercise  and  it  is  preferable  if 
obtained  in  the  form  of  games  with  other  boys.  For 
this  reason  the  best  exercise  for  boys  is  that  obtained 
by  playing  such  games  as  the  following: — baseball,  foot- 
ball, tennis,  cricket,  lacrosse,  hockey,  handball  and  bad- 
minton. 

For  girls:  basket  ball,  skipping  the  rope,  tennis,  golf, 
prisoner's  base,  head-on  and  the  folk-dances  and  games  are 
good. 

For  adults  the  following  are  recommended: — Walking, 
which  is  an  exercise  available  to  all,  is  of  little  benefit  un- 
less the  walk  is  fast  and  far.  Running  is  good  exercise 
if  not  carried  to  the  point  of  exhaustion. 

Horseback  riding  is  one  of  the  best  forms  of  exercise, 
calling  into  play  all  the  muscles  of  the  body,  shaking  up 
the  organs  and  maintaining  the  interest  of  the  rider.  Polo 
is  the  king  of  exercises,  but  available  to  few  on  account  of 
its  expense. 

The  games  baseball,  football,  cricket  and  lacrosse  are 
good  games  for  the  young  adult. 

Bicycling,  rowing,  boxing,  wrestling,  and  fencing  are 
good  sports  and  capital  exercise. 

There  are  few  better  forms  of  exercise  for  the  nimble 
adult  than  hockey,  squash  and  handball.  For  the  man  of 
middle  age  the  best  exercises  are  bicycling,  horseback  rid- 
ing, tennis,  golf,  swimming  and  badminton.  All  exercise 
should  be  taken  in  the  open  air  if  possible.  If  this  is  im- 
possible recourse  may  be  had  to  chest-weights,  dumb-bells, 
Indian  clubs  and  the  army  setting-up  exercises. 

For  those  who  are  unable  to  indulge  in  such  active  ex- 
ercise, or  those  who  require  a  little  more  of  the  intellectual 
element  in  their  exercise,  the  following  are  healthy  forms 
of  recreation: — Gardening,  camping,  yachting  and  boat- 
ing, botanizing,  collecting  of  animals,  birds,  fish,  butter- 


EYE  DISEASES  105 

flies,   insects,    etc. — field   work   in   archeology,    ethnology, 
paleontology,  etc. 

Intellectual  stimulation  on  one  hand,  enjoyment  of  the 
beauties  of  nature  on  the  other  hand  ought  to  fill  out 
the  time  of  recreation  of  every  cultured  person. 

Those  whose  calling  compels  them  to  undergo  bodily 
exertion  and  exercise  in  the  open  air  should  rest  the  body 
during  their  leisure  hours,  and  should  seek  recreation  par- 
ticularly in  intellectual  stimulation,  viz.,  in  enlightened 
discussion,  in  reading  useful  books,  in  contemplation  of 
works  of  art  or  in  the  enjoyment  of  good  music.  On  the 
other  hand,  he  who  is  mentally  occupied,  and  must  spend 
his  hours  of  work  standing  or  sitting  in  closed  rooms, 
should  seek  action  for  his  body  in  his  leisure  hours  by 
suitable  bodily  exercise. 

Social  intercourse  also  affords  congenial  recreation  not 
injurious  to  health  when  confined  within  proper  limits. 

The  exchange  of  thoughts  with  other  people  stimulates 
the  mind  advantageously;  the  communication  of  our  feel- 
ings and  experiences  is  a  necessity  for  most  people  and 
requires  social  conversation  as  well  as  proper  interest  in 
the  pursuits  of  our  fellow-men. 

There  is  a  tendency  to  mental  atrophy  nowadays  through 
taking  our  intellectual  amusements  in  a  predigested  form 
— as  in  the  case  of  many  of  the  present  day  theatrical 
performances  of  little  merit.  A  brain  should  be  very  tired 
before  it  should  be  asked  to  be  content  with  diversions  of 
such  doubtful  benefit. 

Eye  Diseases. — Before  learning  anything  about  the  dis- 
eases of  the  eye,  it  is  desirable  for  you  to  know  the  proper 
names  of  some  of  the  parts  of  the  eye.  The  "white"  of 
the  eye  is  properly  called  the  conjunctiva;  the  colored  part 
is  the  iris,  and  the  dark  center  of  the  eye  is  the  pupil.  The 
pupil  is  really  an  opening  in  the  eyeball,  which  allows  rays 
of  light  to  pass  into  the  eye  in  order  to  reach  the  back  of 
the  eyeball  where  the  optic  nerve  (the  nerve  you  see  with) 
is  spread  out  in  a  delicate  layer  called  the  retina.  If  you 
look  at  your  own  eye  in  the  looking  glass,  with  a  strong 
light,  you  will  see  that  the  pupil  is  very  small.  This  is 
because  the  rays  of  light  are  strong  and  you  don't  need 
many  of  them  to  see  with.  If  you  look  at  your  eye  in  the 
glass  in  a  bad  light,  you  will  see  that  the  pupil  is  much 
larger — it  has  dilated,  in  fact.  So  you  see  that  the  iris 


106  DISEASES  OF  THE  EYE 

is  really  a  movable  circular  curtain,  which  can  open  and 
close  in  order  to  allow  as  much  light  to  pass  into  the  eye 
at  any  moment  as  is  necessary  for  sight.  The  pupil  is  the 
entrance  for  all  rays  of  light,  and  it  is  protected  from  the 
air  by  a  transparent  covering  called  the  cornea.  The 
cornea  is  the  glass  window  of  the  pupil,  so  to  speak,  and 
just  behind  it,  and  behind  the  iris,  is  the  lens  which  collects 
the  rays  of  light  and  focuses  them  on  the  retina. 

Diseases  of  the  Eye. —  (1)  The  cornea  is  very  liable  to 
ulcer ation  and  inflammation.  An  inflamed  eye  cannot  bear 
the  light.  Such  trouble  as  this  is  fairly  common  in  chil- 
dren after  measles.  All  the  forms  of  inflammation  are 
roughly  classed  together  under  the  heading  ophthalmia 
(see  below),  and  the  signs  are  redness,  wateriness,  pain, 
and  dislike  of  light.  Make  the  child  wear  a  green  shade 
over  the  eyes.  Put  a  little  yellow  oxide  of  mercury  oint- 
ment between  the  eyelids  twice  a  day.  Feed  the  child  up. 

(2)  A  more  serious  form  of  ophthalmia  is  the  ulceration 
of  the  cornea,   caused  by  tuberculous  disease.     A  doctor 
must  be  called  in. 

(3)  An  ulcer  or  sore  on  the  eyeball  coming  from  a  slight 
injury  such  as  the  scratch  of  a  twig  or  a  person's  fingers 
may  be  very  serious  indeed.     A  doctor  must  be  called  in  to 
treat  it. 

(4)  Children  with  inherited  syphilis  are  very  liable  to 
cloudiness   of   the   cornea.     (See    also   " Syphilis/')     The 
front  of  the  eye  in  these  cases  gets  to  look  like  ground 
glass  and  then  seldom  improves. 

(5)  "Catarrhal  Ophthalmia. "—This  is  a  very  bad  "cold 
in  the  eye. ' '     The  eyes  feel  as  if  they  had  ' '  grit ' '  in  them ; 
the  conjunctivas  are  bloodshot,  the  eyelids  are  stuck  to- 
gether in  the  morning;  work  is  unbearable,  because  the 
eyes  cannot  bear  light.     This  ophthalmia  is  sometimes  epi- 
demic, generally  in  the  springtime,  and  affects  people  of 
all  ages  and  both  sexes.     The  attack  lasts  about  a  fortnight. 

Treatment. — Use  zinc  sulphate  lotion,  two  grains  to  the 
ounce,  several  times  a  day.  Apply  yellow  oxide  of  mer- 
cury ointment,  four  grains  to  the  ounce  of  vaseline,  be- 
tween the  lids  at  bedtime ;  wear  a  green  eye  shade. 

(6)  "Gonorrheal  Ophthalmia." — This  disease  is  caused 
by  bringing  the  pus  of  the  venereal  disease  called  Gonor- 
rhea to  the  eye  by  the  finger.     It  is  a  terrible  disease  and 
often  ends  in  blindness.     Thousands  of  children  are  blind 


ERRORS  OF  VISION  107 

or  have  defective  vision  because  their  mothers  have  suffered 
from  Gonorrhea.  The  treatment  cannot  be  carried  out 
without  a  doctor. 

(7)  "Granular    Lids." — This    name    speaks    for   itself. 
Among  the  poor  it  is  very  common  to  see  eyelids  which 
are  sore  at  the  edges  and  seem  to  have  been  dusted  over 
with  fine  granules  of  sand.     This  disease,  whether  treated 
or  not,  as  a  rule  drags  on  its  course  for  months  or  even 
years,  and  the  lids  may  become  scarred  and  contracted, 
and  the  eyelashes  may  grow  inwards.     Ulcers  of  the  con- 
junctiva are  common  then,  and  the  sight  is  damaged. 

(8)  "Watery  Eyes." — All  day  long,  whenever  you  blink, 
a  tear  comes  out  of  the  little  tear  gland  lying  at  the  outer 
corner  of  the  eye,  and  is  washed  across  the  eyeball,  and 
escapes  down  a  little  tube,  the  opening  of  which  you  can 
see  at  the  inner  corner  of  the  eye  next  the  nose.     This 
little  tube  is  called  the  tear-duct  and  leads  down  into  the 
nose.     If  the  eye  were  not  washed  continually  like  that,  it 
would  suffer  from  the  grit  and  dust  which  are  always  float- 
ing about  in  the  air.     Sometimes  people  get  a  "cold"  or 
"catarrh"  in  the  tear-duct,  and  it  gets  more  or  less  stopped 
up  for  a  time.     So  the  tears  cannot  escape,  and  remain 
and  make  the  eyes  "watery,"  especially  in  windy  weather. 
If  this  does  not  get  better  in  a  few  days,  a  sort  of  stricture 
of  the  tear-duct  may  develop,  and  then  a  little  operation 
will  be  necessary. 

(9)  "Errors  of  Vision." — If  you  cannot  see  as  well  as 
other  people,  and  if  you  value  your  sight,  do  not  go  to  the 
ordinary  jeweler's  shop,  or  even  to  the  ordinary  optician's, 
or  spectacle-seller's  shop,  but  have  your  eyes  properly  ex- 
amined by  an  oculist,  and  he  will  tell  you  not  only  whether 
you  require  glasses  but  exactly  what  glasses  are  necessary 
to  correct  your  sight.     It  is  a  little  more  expensive,  per- 
haps, to  consult  an  oculist  than  an  optician,  but  the  advice 
and  recipe  for  glasses  once  given,  you  will  probably  not 
need  to  consult  him  again;  and  the  eyesight  is  really  far 
too  precious  to  trust  to  the  tender  mercies  of  a  man  who 
merely  wants  to  sell  glasses,   and  knows  nothing  of  eye 
diseases.     (The  spectacle  makers  are,  we  believe,  to  be  in- 
structed in  the  future  in  the  elements  of  the  treatment  of 
errors  of  vision  by  means  of  spectacles.     This  will  be  a 
real   advantage   to    a   large   section    of   the   public.)     In 
middle-aged  persons  the  power  of  the  eyes,  to  accommodate 


108  FEVER 

themselves  to  all  kinds  of  vision,  sizes  of  print,  distances, 
etc.,  etc.,  is  gradually  growing  less.  At  from  forty  to 
forty-five  years,  even  persons  with  ordinary  sight  begin  to 
require  glasses.  At  forty-five  a  person  with  ordinary  good 
sight  will  require  glasses,  called  plus-one-dioptre  in  order 
to  see  to  read;  at  fifty  he  will  require  two-dioptre  glasses; 
at  fifty-five,  three-dioptre  glasses,  and  so  on  for  every  five 
years  up  to  sixty  or  sixty-five.  A  person  who  has  always 
been  ''long-sighted"  will  need  glasses  for  near  vision 
sooner  than  others.  Short-sighted  people  will  not  need 
glasses  for  near  vision  until  they  are  quite  old. 

Fainting.— When  a  person  faints  lay  him  on  his  back, 
loosen  the  clothes  round  the  neck  and  round  the  waist,  and, 
if  the  person  be  a  tight-laced  woman,  cut  her  stay-laces. 
Then,  if  in  a  moment  or  two  the  patient  does  not  recover, 
throw  cold  water  on  the  face  or  put  smelling-salts  to  the 
nostrils. 

Fever. — Fever  is  an  abnormal  condition  of  the  body  char- 
acterized by  elevated  temperature,  quickened  respiration 
and  circulation,  faulty  secretions  and  increased  tissue 
waste ;  and  dependent  upon  a  perversion  of  the  physiological 
processes  which  usually  so  balance  the  generation  and  loss 
of  heat  that  a  uniform  normal  temperature  is  maintained 
(98.6°  F.). 

Fever  is  caused  by — (1)  Local  inflammations  excited  by 
external  causes,  or  the  products  of  faulty  metabolism  (gout, 
rheumatism) . 

(2)  The  presence  in  the  body  of  microorganisms,  or  of 
toxines  produced  by  them,  as  in  typhoid  fever,  pyaemia, 
diphtheria,  malaria,  etc.  (3)  Paralysis  of  heat-center,  as 
in  thermic  fever. 

The  only  exact  way  of  determining  the  degree  of  fever 
is  by  the  use  of  the  clinical  thermometer.  This  may  be 
inserted  in  the  mouth  under  the  tongue,  under  the  arm- 
pit, or  in  the  rectum  (the  last  method  being  the  one  always 
employed  with  babies).  A  fever  between  normal  or  98.6° 
and  101°  is  considered  slight;  101°  to  104°  moderately  to 
decidedly  high,  104°  to  106°  very  high;  and  above  106° 
hyperpyretic  and  exceedingly  dangerous. 

Before  beginning  to  treat  a  fever  it  is  best,  if  possible,  to 
understand  the  cause.  Then  the  specific  treatment  for  that 
special  form  of  fever  can  be  employed  if  there  is  one. 

In  addition  to  the  specific  treatment  there  is  a  general 


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110  FEVER 

form  of  treatment  of  fevers,  which  is  rarely  contra-indi- 
cated, which  is  especially  to  be  recommended  in  the  early 
stages  of  all  febrile  diseases. 

This  consists  of  rest  in  bed,  a  cool,  well-ventilated  room, 
liquid  or  semi-liquid  diet,  a  mercurial  purgative  such  as 
calomel  (1  or  2  grains)  or  blue  mass,  followed  by  a  saline 
cathartic  such  as  Epsom  or  Rochelle  salts. 

The  elimination  of  the  poisons  causing  the  fever  may 
be  increased  by  drinking  an  abundance  of  water;  by  in- 
creasing perspiration  and  the  fluid  excretions  by  Dover's 
powders,  ammonium  acetate  or  sweet  spirits  of  niter. 
Sponging  the  surface  of  the  body  with  cool  water,  or  water 
and  alcohol,  helps  to  diminish  body  temperature  through 
evaporation.  Among  the  drugs  capable  of  reducing  tem- 
perature may  be  mentioned  quinine,  aconite,  antipyrin, 
phenacetin  and  acetanelid,  but  as  the  last  three  are  coal- 
tar  products,  which  are  somewhat  depressing  to  the  heat, 
they  should  be  used  with  caution. 

As  soon  as  a  specific  cause  has  been  discovered,  that  cause 
should  be  removed  or  the  specific  drug  called  for  should 
be  administered.  For  example,  if  the  cause  of  fever  is  an 
abscess  it  should  be  opened,  cleaned  and  drained.  If  the 
fever  is  malarial,  quinine  should  be  administered ;  if  gouty, 
colchicum ;  and  if  rheumatic,  salicylates. 

Many  of  the  infectious  fevers  are  characterized  by  a 
rash  which  develops  after  a  more  or  less  definite  incuba- 
tion period.  Many  of  these  diseases  are  contagious;  there- 
fore to  prevent  their  spread  they  should  be  quarantined 
until  all  danger  of  their  transmission  has  passed.  The 
preceding  table  gives  the  duration  of  such  a  quarantine, 
the  incubation  period  of  the  disease,  the  character,  time  of 
appearance  and  duration  of  the  rash  and  the  duration  of 
the  illness. 

Diphtheria  is  usually  quarantined  four  weeks,  if  con- 
valescence be  complete,  and  no  sore  throat,  albuminuria 
or  discharges  remain;  and  bacteriological  examination  of 
the  throat  is  on  two  consecutive  occasions  negative. 

Whooping  Cough  is  quarantined  five  weeks  from  the 
commencement  of  the  whooping,  if  the  characteristic  spas- 
modic cough  and  whooping  have  ceased.  Earlier  if  all 
cough  be  gone. 

Mumps  are  quarantined  three  weeks,  if  all  swelling  has 
subsided. 


FITS  AND  "INWARD  FITS"  111 

Fits,  and  "Inward  Fits." — Infants  are  specially  liable  to 
have  what  mothers  call  fits;  some  uneducated  mothers  say 
that  besides  real  fits,  babies  have  inward  fits.  By  this 
latter  name  they  generally  mean  the  grimaces  seen  on 
babies'  faces  when  they  are  suffering  from  indigestion,  and 
have  stomach-ache  and  wind  in  the  stomach  and  bowels. 

Real  fits  are  attacks  of  convulsions,  and  the  presence  of 
convulsions  is  shown  by  violent,  sudden,  and  involuntary 
twitching  of  the  limbs,  clenching  of  the  jaws,  and  rolling 
of  the  eyeballs.  In  some  cases  all  the  muscles  are  affected, 
while  in  others  the  face  only  is  convulsed,  or  the  limbs 
only.  In  full-grown  persons  the  only  fits  of  convulsions 
are  those  due  to  epilepsy — a  well-recognized,  chronic  dis- 
ease, which  renders  a  sufferer  liable  to  convulsive  attacks 
at  uncertain  intervals;  and  fits  occurring  at  the  close  of 
blood  poisoning  from  kidney  disease,  or  resulting  from  an 
apoplexy  due  to  bleeding  on  the  brain.  (See  ''Apoplexy.") 
In  childhood,  however,  fits  of  convulsions  are  quite  com- 
mon, and  may  be  fatal,  without  showing  an  epileptic  consti- 
tution. 

Causes: — Such  fits  may  be  started  by  the  onset  of  fevers, 
or  of  inflammations  of  the  lungs  or  kidneys,  or  by  any 
irritation  within  the  body,  or  on  the  skin;  for  example, 
curdled  milk  in  the  stomach,  a  biscuit  food  if  given  at  too 
early  an  age,  colic,  diarrhea,  ulcers,  coughs,  and  skin  dis- 
eases may  all  set  up  a  series  of  fits;  and  so  many  slight 
operations,  such  as  vaccination,  or  the  application  of  caustic 
to  a  wart,  or  tying  a  thread  around  a  birthmark,  or  circum- 
cision. Convulsions  or  fits  are  dangerous  to  life  by  affect- 
ing the  windpipe  and  so  causing  suffocation  by  spasm; 
convulsions  of  the  muscles  around  the  chest  may  so  hinder 
the  breathing  as  to  cause  death;  and  spasm  of  the  heart 
leads  to  fainting  and  instant  death.  The  occurrence  of  a 
fit  may  point  out  the  presence  of  disordered  digestion,  and 
so  lead  to  prompt  treatment  of  the  stomach  and  bowels, 
which,  under  artificial  feeding  by  the  bottle  or  teaspoon 
with  cow's  or  goat's  milk,  or  with  condensed  milk,  is  much 
more  common  than  when  an  infant  is  suckled.  When 
starchy  foods,  such  as  arrowroot,  maizena,  cornflour,  baked 
wheat  flour,  or  biscuit  are  given  with  milk  to  infants,  there 
is  always  a  risk  of  the  occurrence  of  convulsions  until  a 
baby  is  six  months  old  or  older,  because  until  that  age  is 
reached  the  juices  of  the  stomach  are  unable  to  digest 


112  FLIES 

starch,  and  the  food  gets  into  hard  lumps,  which  do  not 
dissolve.  The  cutting  of  teeth  in  infancy  is  the  other  most 
common  cause  of  fits,  and,  because  it  causes  so  much  pain 
and  disorder  to  the  nervous  system,  it  is  always  wise  to 
take  special  care  of  children  when  teething;  but  in  any 
case  of  convulsive  fits,  send  at  once  for  a  doctor. 

Flies. — Housekeepers  have  for  a  long  time  considered  flies 
as  a  necessary  nuisance.  More  or  less  attempt  has  been 
made  by  many  to  keep  them  out  of  the  house  by  screens 
or  to  kill  them  by  means  of  fly  paper,  but  this  was  done 
principally  because  they  soiled  the  picture  frames  or  the 
chandelier,  or  because  they  were  annoying  when  they  set- 
tled on  the  hands  or  face.  Physicians  and  health  officers, 
however,  have  come  to  the  conclusion  that  the  common, 
ordinary  domestic  fly  that  we  have  tolerated  for  so  long, 
is  not  only  one  of  the  most  disgusting  and  filthy  things 
imaginable,  but,  what  is  worse,  is  probably  the  cause  of 
much  sickness  and  many  deaths. 

The  fly  is  usually  born  in  a  'manure  pile.  Garbage,  dead 
animals,  and  refuse  of  all  kinds  is  selected  by  the  female 
fly  as  a  suitable  place  for  breeding. 

The  fly  is  not  at  all  particular  as  to  his  food;  he  likes 
milk  and  cake  and  most  all  the  kinds  of  food  people  eat, 
but  he  can  also  be  seen  enjoying  a  hearty  meal  off  the 
contents  of  a  privy  vault,  off  the  expectoration  from  a  con- 
sumptive, the  discharges  from  sores  on  animals  and  men, 
and  many  other  equally  repulsive  substances. 

The  dirty  habits  of  the  fly  ought  to  be  enough  to  disgust 
anyone  and  make  him  a  determined  enemy  of  the  pest; 
but,  to  make  matters  worse,  the  fly's  liking  for  these  re- 
pulsive things  makes  him  a  positive  source  of  danger.  The 
food  of  a  fly  is  not  served  on  a  diminutive  plate,  but  he 
steps  right  into  it ;  and  he  not  only  eats  all  that  he  wants, 
but  he  gets  his  legs  and  body  and  wings  more  or  less 
covered  with  whatever  filth  he  is  eating.  And  the  filth 
he  so  often  chooses  contains  myriads  of  germs  of  disease. 

By  use  of  the  microscope  it  has  been  shown  that  on  a 
single  fly  there  may  be  as  many  as  6,500,000  bacteria  or 
germs;  the  average  number  is  probably  about  1,250,000. 
These  are  not  all  disease  germs,  for  there  are  bacteria  that 
are  harmless ;  but  a  few  typhoid  germs  from  a  privy  vault, 
or  tubercle  bacilli  from  a  cuspidor  or  from  an  expectora- 
tion on  the  ground,  or  a  small  number  of  germs  of  diar- 


FIIES  113 

rheal  disease  from  the  sewage-soiled  bank  of  a  stream  are 
enough  to  cause  fatal  illness. 

And  some  of  the  filth  and  germs  on  the  legs  of  the  fly 
are  going  to  be  deposited  on  the  very  next  thing  he  settles 
on;  it  may  be  milk  in  the  pitcher  or  pail,  it  may  be  the 
fruit  or  vegetables  exposed  for  sale,  it  may  be  the  bread 
or  cake,  it  may  be  the  nipple  of  the  baby's  bottle,  or  it 
may  be  the  lips  or  face  of  the  child  as  it  lies  asleep. 

The  many  cases  of  typhoid  fever  that  occurred  among 
the  American  soldiers  in  the  various  camps  at  the  time  of 
the  Spanish  war  were  mainly  due  to  the  flies  which  had 
access  both  to  the  bowel  and  bladder  discharge  of  the  sol- 
diers and  to  their  food. 

Other  diseases  which  may  be  transmitted  by  the  flies  are 
summer  diarrhea,  infantile  paralysis,  cerebro-spinal  men- 
ingitis, tuberculosis,  trachoma,  septicaemia,  erysipelas, 
cholera,  plague,  anthrax  and  the  intestinal  parasites  such 
as  tapeworms  (through  contamination  of  food  by  the  eggs). 

The  fly  is  more,  then,  than  a  mere  nuisance;  it  is  a 
positive  enemy  to  life  and  health  and  must  be  exterminated. 
And  everyone  must  join  in  and  do  his  share  in  this  work. 
We  must  all  try  to  stop  the  breeding  of  flies,  and  we  must 
all  do  all  we  can  to  kill  those  that  are  born  and  to  prevent 
them  from  carrying  disease. 

The  life  cycle  of  the  fly. — The  eggs  of  the  fly  are  de- 
posited upon  putrefactive  animal  or  vegetable  matter. 
From  the  eggs  emerge  the  larvae  or  maggots,  which  feed 
upon  the  decaying  material.  After  a  variable  number  of 
days,  they  shut  themselves  into  their  skin,  forming  a  hard 
case  (puparium)  around  themselves,  from  which  they 
emerge,  by  a  marvelous  transformation,  as  winged  insects. 
A  single  fly  lays  120  to  140  eggs;  the  larvae  or  maggots 
leave  the  eggs  at  the  earliest  eight  hours  after  laying; 
they  mature  in  five  to  eight  days,  then  pupate;  the  pupae 
mature  in  five  to  seven  days,  the  cycle  from  egg  to  fly 
requiring  at  least  ten  days. 

All  stable  manure  and  filth  should  be  kept  in  a  vault  or 
pit  from  which  flies  are  shut  out  by  screens,  and  lime 
should  be  sprinkled  freely  and  frequently  over  the  contents 
of  the  pit.  This  will  not  injure  the  value  of  the  manure 
as  fertilizer,  but  it  will  stop  the  breeding  of  flies.  As 
ninety-eight  flies  out  of  every  hundred  are  born  in  a  ma- 
nure pile,  this  ought  to  do  away  with  a  vast  number  of 


114  FOMENTATIONS 

flies,  and  it  is  the  most  important  measure  in  the  war  of 
extermination.  It  is  well  to  bear  in  mind,  too,  that  it 
takes  ten  days  for  the  fly  to  develop  from  the  egg;  so  if 
manure  is  removed  about  once  a  week  and  spaded  into  the 
ground,  flies  in  process  of  development  will  be  destroyed 
before  they  reach  maturity. 

The  other  places  in  which  flies  breed  must  also  be  looked 
after.  Garbage  should  be  kept  in  a  covered  receptacle, 
and  no  refuse  should  be  allowed  to  collect  where  flies  can 
get  at  it.  Dead  animals  should  be  promptly  removed  and 
buried  or  burned. 

Privy  vaults  should  be  so  constructed  as  to  exclude  flies. 
Openings  for  ventilation,  etc.,  should  be  screened  with 
wire  or  mosquito  netting,  and  all  cracks  in  the  walls  or 
openings  under  the  bottom  should  be  closed. 

Doors  and  windows  of  houses  should  be  screened,  espe- 
cially in  the  kitchen  and  dining-room,  and  any  room  in 
which  there  is  a  case  of  sickness.  And  care  should  be 
taken  to  see  that  the  screens  fit  accurately,  and  that  they 
are  always  in  place,  and  that  screen  doors  are  not  left 
ajar  or  held  open.  If  wire  screens  cannot  be  afforded  flies 
can  be  kept  out  by  cotton  mosquito  netting  tacked  over  the 
windows.  A  piece  of  netting  containing  sixteen  square 
yards  can  be  bought  for  half-a-dollar. 

Flies  that  do  get  into  the  house  should  be  chased  and 
killed,  or  should  be  caught  by  fly  paper,  etc.  All  dead  flies 
should  be  promptly  burned. 

Don't  ~buy  food  exposed  for  sale  in  places  where  flies  can 
get  to  it. 

Our  houses  are  not  the  only  places  where  fly  screens 
should  be  used.  Slaughterhouses,  butcher  shops,  markets, 
candy  stores,  grocery  stores,  bakeries,  and  the  wagons  of 
food  peddlers  of  all  kinds — every  place  where  any  kind  of 
food  is  handled  or  sold — should  be  screened.  Flies  should 
never  be  allowed  to  come  in  contact  with  anything  that  is 
to  be  eaten. 

Fomentations  are,  on  the  whole,  better  than  poultices. 
They  are  made  with  flannel  or  lint,  or  boric  lint — best  of 
all.  The  lint  is  wrung  out  of  boiling  water  in  which  poppy 
heads  have  been  soaking.  To  wring  out  warm  cloths  with 
the  hands  is  quite  impossible,  if  the  fomentation  is  to  be 
as  hot  as  it  ought  to  be,  and  in  the  process  of  wringing 
much  heat  is  lost.  So  in  every  household  there  ought  to 


FOODSTUFFS  EXPOSED  TO  DIRT       115 

be  a  wringer,  which  is  thus  made: — Take  a  towel,  or  a 
piece  of  coarse  towelling,  or  a  piece  of  bed  ticking,  twelve 
inches  wide  and  thirty  inches  long.  Make  a  hem  at  each 
end  wide  enough  to  form  a  channel  for  a  stick  of  about 
eighteen  inches  long.  Two  pieces  of  broomstick  will  do 
nicely.  To  use  the  wringer,  put  it,  with  the  fomentation 
lint  folded  into  a  pad  on  it,  in  boiling  water,  or  else  pour 
boiling  water  on  to  it,  and  then  seize  the  sticks,  twist  them 
in  opposite  directions  so  as  to  squeeze  all  superfluous  water  • 
out  of  the  fomentation.  Untwist  it  again  rapidly,  seize  the 
fomentation,  smooth  it  out,  place  it  on  the  body,  cover  it 
with  a  bit  of  oil-silk,  and  then  a  pad  of  cotton-wool  and  a 
bandage.  Apply  another  fomentation  before  the  first  gets 
cold. 

Foodstuffs  Exposed  to  Street  Dust  and  Dirt. — Foodstuffs 
exposed  on  the  streets  may  become  contaminated  by  dust 
(see  "Dust")  and  flies  (see  "Flies")  and  consequently  a 
source  of  disease  when  eaten  in  the  uncooked  state. 

Regulations  such  as  the  following  are  now  enforced  by 
many  boards  of  health  and  should  do  much  to  ensure  the 
safety  of  our  food  supply. 

A.  The  following  are  prohibited  from  being  displayed 
for  sale  outside  any  premises  or  in  any  street  or  public 
place  unless  covered  so  as  to  be  protected  from  dirt,  flies 
and  other  contamination. 

1.  Pastry — bread,  pies,  rolls,  cake. 

2.  Sliced  fresh  fruit,  such  as  watermelon  and  oranges 
when  cut  open. 

3.  Dried  or  preserved  fruits — dates  and  figs. 

4.  Candies   or   confectionery    (does   not  include   candy 
exposed  for  sale  when  wrapped  in  paper). 

5.  Perishable  food  products  which  are  not  pared,  peeled 
or  cooked  before  consumption,  which  includes :     (a)  Plums ; 
(b)  Berries;  (c)  Grapes. 

B.  The  following  shall  not  be  hung  or  exposed  for  sale 
in  any  street  or  outside  of  any  shop  or  store  or  in  any 
open  windows  or  doorways  thereof: 

1.  Meat. 

2.  Poultry. 

3.  Game  (except  rabbits). 

4.  Fish. 

C.  The  body  of  any  animal,  or  any  part  thereof,  used 
for  human  food  shall  not  be  carted  or  carried  through  the 


116  GAIT  AND  APPEARANCE 

streets  unless  covered  so  as  to  be  protected  from  dust  and 
dirt. 

Gait  and  Appearance. — Every  doctor  cultivates  as  much, 
as  possible  the  faculty  of  observation.  He  is  called  in 
to  a  patient  and  has  patiently  to  listen  to  a  long  rigmarole 
of  complaints  and  description  of  illness,  and  he  has  to  ar- 
range what  he  has  learned  in  a  methodical  way,  asking 
questions  to  fill  up  the  blanks  in  the  information  given, 
and  at  last  he  makes  up  his  mind  what  is  wrong  with  the 
patient  and  decides  what  treatment  will  do  him  good. 
But  the  clever  doctor  has  more  to  do  than  that.  He  has  to 
notice  that,  very  often  in  the  case  of  women  patients,  the 
account  given  is  not  quite  truthful.  Willfully  or  igno- 
rantly  the  sick  person  has  misrepresented  or  exaggerated 
something.  So,  all  the  time  that  the  talking  is  going  on, 
the  doctor  observes  little  details,  and  draws  his  conclusions 
far  more  from  what  he  sees  than  from  what  he  hears.  When 
a  patient  approaches  a  doctor  in  his  consulting  room,  he 
walks  towards  him,  and  from  his  very  gait  and  appearance 
there  may  be  a  great  deal  to  be  learned.  Sometimes  it  is 
possible  to  "diagnose"  a  disease  at  the  first  sight  of  a 
patient,  just  as  you  can  diagnose  a  cold  in  the  head  from 
seeing  a  person  with  watery  eyes  using  his  handkerchief 
to  blow  his  nose !  Note  the  elastic  confident  tread  of  a  man 
in  good  health;  the  shambling  gait  of  the  public-house 
loafer;  the  dragging  of  the  feet  in  people  who  are  tired. 
If  a  child  cannot  walk  when  it  is  a  year  and  six  months 
old,  you  can  safely  diagnose  stupidity,  paralysis,  or  rickets. 
A  child  with  St.  Vitus'  dance  walks  jerkily  and  oddly,  and 
perhaps  twitches  with  hands  and  face  at  the  same  time. 
In  paralysis  agitans,  the  trembling  palsy  seen  sometimes  in 
old  age,  the  person  totters  along,  getting  quicker  as  he  goes, 
and  at  last  is  unable  to  stop  himself  except  by  running 
against  a  chair  or  wall.  His  steps  are  all  very  short. 

In  locomotor  ataxia  the  patient  looks  to  see  where  he  is 
putting  his  feet;  he  lifts  his  foot  high  in  the  air  in  order 
to  be  sure  to  clear  the  ground,  and  brings  it  down  on  the 
pavement  again  with  force.  When  he  tries  to  turn  sud- 
denly, he  nearly  falls  down;  he  cannot  walk  unless  he  can 
see  his  feet.  In  alcoholic  paralysis  the  foot  is  "dropped" 
and  it  has  to  be  lifted  high  in  order  to  clear  the  ground 
and  the  knee  is  much  bent.  In  flat  foot  the  person  walks 
with  his  toes  turned  out.  The  person  with  hip-joint  dis- 


GENERAL  PARALYSIS  117 

ease  takes  a  long  step  with  the  sound  leg  and  swings  round 
the  other  one,  thus  walking  lopsided. 

Gallstones. — A  gallstone  is  a  little  dried-up  mass  of 
bile-materials  which  forms  in  the  gall  bladder.  When  the 
stone  is  pressed  through  the  gall  tube  into  the  intestine, 
it  is  sometimes  too  large  to  pass  easily,  and  causes  violent 
colic  in  the  belly,  which  continues  until  it  gets  out  of  the 
narrow  tube  into  the  gut.  The  main  symptom  is  intense 
pain  on  the  right  side,  occurring  in  spasms. 

It  must  be  carefully  differentiated  from  appendicitis, 
which  occurs  lower  down  on  the  right  side. 

The  most  common  causes  are  sedentary  habits,  a  rich 
diet,  and  diseases  of  the  liver  and  bile  ducts — and  not 
infrequently  following  typhoid  fever.  The  pain  is  fre- 
quently accompanied  by  a  well-marked  jaundice. 

Hot  fomentations  may  sometimes  relieve  the  pain.,  but 
morphine  may  be  necessary. 

An  attack  of  gallstone  colic  may  terminate  at  any  time 
in  a  surgical  condition  demanding  operation,  therefore  a 
physician  should  always  be  summoned  during  such  an 
attack. 

The  medical  treatment  consists  of  a  regulated  diet, 
largely  vegetable,  and  systematic  exercise  between  attacks. 
Mineral  waters,  sodium  phosphate,  calomel  or  podophyllin, 
and  salol  or  urotropin  are  useful  drugs. 

Gangrene,  or  Mortification. — This  name  is  given  to  the 
death  of  a  part,  as  of  a  finger,  or  of  a  foot,  or  of  a  portion 
of  flesh  in  a  wound.  It  follows  very  severe  local  injuries, 
when  the  blood  supply  is  stopped  by  the  tearing  or  wound- 
ing of  arteries  and  veins ;  the  same  results  occur  when  the 
blood  vessels  are  blocked  by  firm  clots,  as  sometimes  occurs 
in  weakly,  aged  persons.  Gangrene  may  be  of  the  dry 
form  in  which  the  parts  wither  up,  or  "slough,"  or  of  the 
moist  form,  in  which  the  parts  become  a  sodden  decaying 
mass.  The  gangrene  may  lead  to  blood  poisoning  and 
death,  but  there  may  be  a  chance  of  prolonging  life  if  the 
part  affected  can  be  removed  by  the  knife — (amputation). 

General  Paralysis. — This  disease  is  nowadays  treated  in 
asylums,  and  the  sooner  the  afflicted  person  gets  off  to 
where  he  can  be  suitably  looked  after  the  better  for  every- 
body. The  disease  begins  generally  in  the  thirties.  The 
average  age  of  death  is  forty.  It  affects  all  classes,  espe- 
cially of  townspeople,  men  oftener  than  women.  The  most 


118  GIDDINESS 

important  cause  is  "Syphilis"  (which  see),  and  other 
causes  are  mental  worry,  overwork,  alcoholism,  and  head 
injury.  It  would  be  useless  in  a  book  like  this,  to  give  a 
long  account  of  the  disease,  and,  as  it  is  incurable,  nothing 
need  be  said  about  treatment.  The  earlier  signs  by  which 
the  disease  may  be  known  are : — 

(1)  Changed  mental  condition — jealousy,  bad  temper, 

fancies,  illusions,  delusions,  loss  of  memory,  ex- 
travagance of  ideas,  filthy  and  degrading  habits. 
The  patient  sometimes  shows  the  first  sign  of 
the  disease  when  he  goes  to  a  shop  and  orders 
quantities  of  things  he  does  not  want  and  cannot 
pay  for.  Also,  when  he  brags  about  his  mil- 
lions of  money  and  watches  and  jewels  when  he 
is  really  poor. 

(2)  Later,  the  pupils  of  the  eyes  are  seen  to  be  un- 

equal, he  loses  the  power  to  write,  etc.,  and  at 
last  becomes  helpless  and  bedridden. 

Giddiness. — The  medical  name  for  this  ailment  is  vertigo, 
it  is  derived  from  a  Latin  word  meaning  to  turn  round, 
and  the  principal  feature  of  giddiness  is  a  sensation  that 
the  room  and  objects  around  are  turning  round  you,  not 
that  you  yourself  are  turning  round. 

Giddiness  may  be  only  occasionally  felt,  and  it  may  come 
on  quite  suddenly,  and  may  as  quickly  disappear,  or  it  may 
occur  and  not  be  got  rid  of  for  hours  or  days.  It  may 
occur  as  the  only  symptom  of  ill-health,  or  it  may  be  asso- 
ciated with  headache,  and  nausea,  or  sickness. 

Giddiness  is  certainly  a  symptom  due  to  a  momentary 
fault  in  the  circulation  in  the  brain,  and  may,  of  course, 
be  due  to  actual  brain  disease,  but  in  general  the  cause 
of  giddiness  is  to  be  found  in  disturbances  of  the  digestive 
organs,  and  particularly  from  biliousness  and  other  liver 
troubles. 

One  form  of  giddiness  can  be  brought  on  intentionally 
by  many  persons,  by  turning  round  quickly  while  standing 
upon  one  heel,  or  by  waltzing ;  many  others  feel  giddy  when 
on  the  moving  deck  of  a  vessel  at  sea;  others,  again,  feel 
giddy  when  looking  down  from  a  high  place,  or  over  a 
precipice. 

Nervous  persons  who  have  had  one  real  attack  are  apt 


GLANDS,  SWOLLEN  119 

to  fancy  they  feel  it  coming  on  again;  in  severe  cases  of 
nervous  debility  patients  may  feel  giddy  whenever  they 
get  up  from  their  beds  or  from  their  seats ;  others  are  afraid 
to  cross  open  spaces  for  fear  of  falling. 

Giddiness  is  commonly  felt  by  patients  who  have  lost 
much  blood,  or  who  are  exhausted  by  fever  or  any  wasting 
illness.  Anaemic  girls,  pale  from  want  of  sufficient  healthy 
blood,  are  subject  to  attacks  of  giddiness. 

This  ailment  is  also  related  to  epilepsy,  for  when  such 
sufferers  have  passed  through  an  attack  or  epileptic  fit, 
they  tell  you  it  began  by  a  giddy  feeling. 

Persons  who  are  very  robust,  who  eat  much  more  than 
they  need,  and  are  too  full-blooded,  are  subject  to  giddiness. 
Certain  peculiar  defects  of  eyesight  lead  to  this  unpleasant 
symptom,  and  there  is  a  disease  of  the  internal  ear,  called 
Meniere's  Disease,  in  which  giddiness  is  associated  with 
deafness. 

The  poisonous  principles  of  tobacco  produce  a  giddy 
feeling  in  persons  who  are  attempting  to  smoke  for  the 
first  few  times,  and,  of  course,  everyone  knows  that  alco- 
holic drinks  taken  to  excess,  cause  such  giddiness  as  to 
make  men  stagger  and  fall  down. 

In  general  we  may  say  that  if  a  person  in  good  ordinary 
health  becomes  giddy,  the  safest  remedy  to  employ  is  a 
thorough  good  purgative  dose  of  sulphate  of  magnesia  in 
water. 

Glands,  Swollen. — When  an  enlarged  gland  is  formed  on 
a  person  who  is  in  good  health,  we  may  be  fairly  sure  that 
the  swelling  is  curable,  because  its  cause  is  not,  as  a  rule, 
far  to  seek,  and  can  be  removed.  Enlarged  glands  occur 
in  certain  situations.  These  are  chiefly,  the  neck  below  the 
jaw,  and  just  below  the  ear,  the  groins,  the  armpits  and 
just  above  the  elbows. 

Now  in  each  of  these  situations  there  are  groups  of 
" glands"  which  are  called  "lymphatic  glands"  in  which 
the  blood  circulates,  and  in  which  the  blood  undergoes 
certain  changes,  fitting  it  for  recirculation.  If  you  cut 
or  scratch  your  finger  or  foot  with  a  dirty  instrument  or 
pin,  the  poison  enters  the  skin  through  the  wound,  goes 
into  the  blood,  and  is  carried  upwards  towards  the  body. 
If  the  poison  could  get  into  the  body  (or,  when  it  does) 
you  become  ill  for  a  time.  But  if  you  are  in  good  health 
the  set  of  glands  which  lie  between  the  cut  or  wound  and 


120       GOITER,  OR  DERBYSHIRE  NECK 

the  heart  try  their  best  to  stop  the  poison,  and  to  destroy 
it  there.  But  if  the  poison  is  too  much  for  them,  then  the 
glands  begin  to  swell  from  the  irritation  of  the  poison, 
and  get  red,  hot,  and  inflamed.  As  a  fact  the  inflammation 
is  Nature's  way  of  getting  rid  of  the  poison.  Ear  disease, 
decayed  teeth,  enlarged  tonsils,  and  vermin  may  all  cause 
the  neck  glands  to  be  swollen.  The  cause  must,  of  course, 
be  dealt  with  in  every  case. 

Enlarged  glands  in  the  groin  are  produced  by  gonor- 
rhea, syphilis,  and  by  the  poison  from  a  sore  place  on  the 
leg  or  foot. 

A  swollen  gland  or  ' '  bubo ' '  will  very  often  get  better  by 
itself,  especially  if  poulticed.  But  often  it  becomes  an  ab- 
scess, and  then  the  matter  or  pus  must  be  let  out  by  a  cut 
with  a  surgeon's  knife.  It  must  not  be  forgotten  that 
persons  with  consumptive  tendencies  are  most  liable  to 
enlarged  glands  and  these  must  be  dealt  with  according  to 
the  case.  Sometimes  it  is  wise  to  leave  them  alone  and 
they  will  gradually  disappear.  At  other  times  they  will 
have  to  be  dissected  out,  or  scraped  out,  according  to  their 
condition.  In  all  cases  cleanliness  must  be  observed,  sores 
must  be  healed,  and  decayed  teeth  must  be  attended  to. 
(See  also  " Abscess.") 

Goiter,  or  Derbyshire  Neck  (See  also  " Cretinism").— 
By  goiter  is  meant  a  swelling  in  the  thyroid  gland,  an 
organ  lying  on  the  front  of  the  neck ;  in  health  it  is  neither 
seen  nor  felt,  being  very  small  and  soft,  but  in  goiter  it 
may  swell  up  to  a  very  large  size,  making  a  huge,  bulging 
tumor  (on  one  or  both  sides  of  the  middle  line),  which  is 
not  painful,  nor  hot,  nor  inflamed.  It  grows  gradually 
and  has  but  little  tendency  to  go  away,  unless  it  is  con- 
tinuously treated;  it  is  apt  to  appear  first  in  childhood 
from  7  to  12  years  old,  and  may  last  a  lifetime  without 
causing  serious  illness.  It  is  most  common  in  people  who 
live  in  valleys  among  mountains,  and  may  be  due  to  habit- 
ual drinking  of  very  hard  water. 

In  treatment,  the  first  requisite  is  to  remove  the  patient 
from  the  locality  where  the  goiter  has  started,  if  it  be  one 
where  cases  are  of  frequent  occurrence;  in  all  cases,  how- 
ever, change  of  air,  scene,  climate,  and  food  are  desirable. 
Put  the  patient  under  the  most  healthy  conditions,  and 
with  plenty  of  open-air  exercise  and  good  food.  The  most 
successful  remedy  is  iodine  given  internally  in  many  forms, 


GONORRHEA  121 

such  as  iodide  of  sodium,  iodide  of  potassium,  or  iodide  of 
iron,  together  with  the  external  application  of  iodine  oint- 
ment or  a  mercurial  ointment.  Of  recent  years  it  has  been 
found  that  many  cases  improve  when  treated  by  doses  of 
the  extract  of  the  thyroid  gland  of  the  sheep ;  this  can  now 
be  obtained  in  many  forms,  as  a  liquid  medicine,  or  as  a 
powder  or  pills  or  tabloids. 

Another  form  of  goiter  is  that  commonly  called  Grave's 
disease,  and  in  this  case  the  disease  has  no  relation  to 
climate,  soil  or  water,  and  is  accompanied  by  a  peculiar 
state  of  the  heart  and  great  blood  vessels.  The  swollen 
neck  is  associated  with  protruding  eyeballs  which  give  a 
most  notable  appearance  to  the  face,  and  yet  the  eyeballs 
are  in  no  way  diseased;  there  are  also  present  a  highly 
nervous  state,  shortness  of  breath  and  palpitation  of  the 
heart  with  throbbing  in  the  blood  vessels.  This  disease 
is  also  called  "Exophthalmic  goiter."  It  can  be  in  no 
way  treated  by  domestic  remedies  with  any  hope  of  giving 
relief. 

Gonorrhea. — Gonorrhea  is  a  disease  which  one  is  ex- 
ceedingly liable  to  contract  upon  departing  from  the  moral 
mode  of  living.  It  is  readily  transmitted  from  one  sex 
to  the  other  and  among  married  people  may  thus  be  trans- 
mitted from  the  guilty  to  the  innocent.  It  is  a  cause  of  a 
large  part  of  the  pelvic  inflammatory  conditions  for  which 
women  require  surgical  operations  and  is  the  cause  of  a 
great  deal  of  misery  in  the  world. 

The  most  important  thing  to  remember  about  gonorrhea 
is  that  until  it  is  entirely  cured  it  can  be  readily  trans- 
mitted. 

In  this  disease,  in  the  male,  there  is  an  inflammation  of 
the  urethra  (the  pipe  for  the  passing  of  the  urine),  which 
gives  rise  to  severe  pain  and  smarting,  especially  on  pass- 
ing water,  and  very  often  to  much  general  illness  as  well; 
fever,  loss  of  appetite  and  weakness,  in  addition  to  the 
continual  discharge  of  pus  from  the  pipe.  The  disease  is 
often  the  starting  point  of  months  or  years  of  severe  ill- 
ness and  pain.  Most  cases  are  curable  by  the  surgeon, 
especially  if  the  treatment  be  conscientiously  carried  out, 
but  many  half-cured  cases  get  tired  of  being  doctored, 
return  to  their  immoral  ways  and  are  a  real  menace  to 
society,  to  themselves,  and  to  future  generations. 

The  disease,  in  man,  has  dozens  of  possible  complications. 


122  GOUT 

Among  the  more  serious  ones  are  stricture,  bladder  disease, 
abscess  of  the  kidney,  ophthalmia  which  may  lead  to  blind- 
ness, and  gonorrhea!  rheumatism.  This  last  disease,  which 
occasionally  affects  women  also,  is  in  many  cases  incurable, 
and  in  all  cases  very  difficult  to  treat. 

Gout. — This  is  a  very  large  subject,  and  it  is  difficult  to 
know  where  to  begin  to  discuss  it.  It  is  pretty  certain 
that  the  word  ought  to  be  used  to  mean  a  very  large  group 
of  symptoms,  such  as  are  referred  to  under  such  loose 
expressions  as  "goutiness,"  " gouty  tendency,"  and  the 
like.  We  are  obliged  to  say  that,  notwithstanding  the 
immense  amount  of  research  and  study  which  have  been 
devoted  to  gout,  we  are  not  much  nearer  a  thorough  under- 
standing of  how  it  is  caused.  We  know  more  about  how 
to  guard  against  it,  and  how  to  treat  it.  But  it  is  so  mixed 
up,  in  many  cases,  with  something  of  a  rheumatic  nature, 
that  it  is  hard  to  cure,  and  sometimes  even  very  hard  to 
relieve.  The  word  gout  comes  from  the  French  word 
goutee  (a  drop),  and  from  the  Latin  word  gutta  (a  drop)  ; 
and  we  are  still  obliged  to  say  (as  the  old  Romans  and 
Greeks  did)  that  gout  is  the  result  of  the  gradual  deposits 
of  drops  of  some  material  in  the  joints  and  elsewhere.  We 
now  know  that  the  material  is  called  bi-urate  of  sodium 
(a  chemical  substance  derived  from  uric  acid),  and  we 
know  that  it  is  deposited  as  a  result  of  some  defect  in  the 
kidneys  which  prevents  their  getting  rid  of  some  of  the 
waste  matters  in  the  blood.  But  this  defect  is  also  con- 
sidered to  be  a  result  of  something  wrong  with  the  nervous 
apparatus  of  the  body.  Gout,  in  fact,  is  a  nervous  disease 
(in  one  sense),  characterized  by  defective  action  of  the 
kidneys  and  hence  in  storing-up  of  waste  matters  in  the 
body. 

Causes. — The  people  who  have  gout  are  mostly  those  who 
— in  the  first  place — have  what  doctors  call  a  neurotic 
family  history  (see  " Neurosis"),  and,  in  the  second  place, 
those  whose  kidneys  are  not  equal  to  the  strain  of  getting 
rid  of  waste  matters  from  the  food.  Men  are  more  liable 
to  gout  than  women ;  but,  perhaps,  women  are  more  apt  to 
have  "rheumatic  gout." 

Note  that  the  heredity  of  this  disease  is  so  strong  that 
many  persons  who  are  and  always  have  been  strictly  tem- 
perate and  moral  and  careful,  yet  suffer  from  gout.  But 
no  doubt,  a  steady  life  in  a  gouty  subject  makes  it  unlikely 


GOUT  123 

that  he  will  be  troubled  much  with  gouty  attacks.  Paint- 
ers and  plumbers  are  liable  to  be  gouty,  because  lead 
poisoning  is  apt  to  cause  the  disease. 

The  two  chief  varieties  of  acute  gout  are — regular  gout, 
which  is  gouty  swelling  of  a  joint,  and  irregular  gout,  which 
is  gouty  pain  and  inflammation  of  some  other  part  of  the 
body. 

Signs  of  an  attack  of  gout  in  a  joint. — Many  people  get 
a  warning  that  there  is  going  to  be  an  attack,  a  day  or  two 
before.  Such  warning  may  be — wind  in  the  stomach,  numb- 
ness of  fingers  and  toes,  irritability  of  temper;  sometimes 
patients  feel  livelier  than  usual.  The  patient  goes  to  bed 
all  right,  and  wakes  up  in  the  night,  shivering  and  fever- 
ish, just  before  an  attack,  with  violent  pain  in  a  joint — 
generally  the  big-toe  joint. 

The  gouty  joint  is  so  tender  and  so  painful  that  the 
patient  cannot  bear  the  weight  of  the  bedclothes,  and  hates 
to  be  touched.  The  skin  over  the  joint  is  red,  tight,  and 
shiny.  After  a  few  hours  the  pain  abates,  and  is  better 
during  the  daytime;  but  comes  on  again  next  night;  thus 
continuing  for  about  ten  days.  Then  the  skin  over  the  joint 
gets  paler  and  peels  off.  While  the  attack  is  going  on  the 
patient  is  very  bad-tempered,  thirsty  and  dyspeptic.  After 
it  is  over  he  feels  better  than  he  has  done  for  years.  Then, 
sooner  or  later,  another  attack  comes. 

Treatment  for  an  attack : — 

(1)  Send  for  the  doctor. 

(2)  Don't  use  arnica,  or  poultices,  or  ice  for  a  gouty 
joint. 

(3)  If  the  pain  is  bearable,  wrap  up  the  joint  in 
plenty  of  cotton-wool,  covered  with  oil-silk,  and  lightly 
bandaged. 

(4)  Otherwise,  put  the  feet  in  a  hot  foot  bath  of 
water  in  which  are  several  poppy  heads    (obtainable 
from    the    chemist).     Or    apply    Baume    Analgesique 
Bengue  to  the  joint  and  wrap  it  up  in  gauze  or  flannel. 
Keep  the  part  elevated. 

(5)  Let  the  sufferer  send  out  for  an  ounce  of  colchi- 
cum  wine  and  let  him  take  40  drops  of  it  at  once  in  a 
wineglassful  of  water.     He  will  have  to  go  on  taking 
colchicum  in  some  form  or  other  for  some  time;  but 
colchicum  has  a  certain  depressing  effect  on  the  heart, 


124  GROG  BLOSSOMS 

and  no  sensible  man  will  take  it  without  being  super- 
vised by  his  doctor.  We  only  recommend  him  to  take 
those  40  minims  in  case  the  doctor  might  be  delayed. 

(6)  Diet  to  be  very  light — do  not  give  concentrated 
meat  essences. 

Signs  of  Chronic  Gout. — Dyspepsia,  stone  in  the  kidney, 
swollen  and  knobby  finger  and  toe  joints  with  lumps  of 
chalkstones,  skin  eruptions,  irritable  heart,  muscular  pains, 
etc. 

Treatment  of  a  gouty  tendency. — In  young  men  gout  is 
avoidable  and  curable,  especially  if  they  become  teetotalers. 
There  must  be  no  greediness,  nor  gormandizing,  and,  in 
fact,  the  less  meat  and  pastry  gouty  people  eat,  the  better 
for  them.  Indolent  habits  are  to  be  given  up.  Lots  of  ex- 
ercise must  be  taken.  Everybody  who  fears  gout  should 
take  a  heaped-up  teaspoonful  of  phosphate  of  soda,  and 
wash  it  down  with  a  pint  of  clean  water,  every  morning  of 
his  life,  before  breakfast.  When  a  person  has  all  sorts  of 
pains  and  aches  due  to  goutiness,  he  must  be  more  careful 
with  his  diet,  and  he  may  take  the  following  medicine : — 
Bicarbonate  of  potassium,  6  drachms;  iodide  of  potassium, 
2  drachms;  colchicum  wine,  2  fluid  drachms;  camphor 
water,  to  12  ounces  (mix).  Take  a  tablespoonful  of  this 
mixture,  thrice  daily,  in  a  wineglassful  of  water,  after  meals. 

Grog  Blossoms. — We  should  be  very  careful  how  we  use 
this  vulgar  and  unscientific  name  of  the  disease  which  doc- 
tors call  "Rosacea,"  for  though  drink  is  often  the  cause 
of  it,  or  at  least,  the  circumstance  which  keeps  it  up,  yet 
"grog  blossoms"  are  occasionally  seen  on  the  faces  of  per- 
sons who  claim  to  be  quite  temperate  and  even  teetotal. 
At  first  the  red  flush  comes  on  just  after  eating  or  after 
exposure  to  the  cold.  Many  women  get  red  noses  in  the 
open  air  on  a  cold  day.  If  it  gets  worse  the  whole  of  the 
middle  part  of  the  face,  cheeks  and  nose,  get  permanently 
red  and  the  little  blood  vessels  of  the  surface  of  the  skin 
get  enlarged  and  visible.  After  a  time  this  too-great  nour- 
ishment of  the  skin  of  the  nose  causes  the  skin  glands  to 
overwork  themselves,  and  so  the  skin  gets  shiny  and  greasy 
and  scaly  as  well  as  red.  Then  the  skin,  if  at  all  coarse  in 
texture,  gets  covered  with  holes  and  pimples,  and  this  con- 
dition has  given  rise  to  the  vulgar  word  "grog  blossoms." 
In  cabmen  and  men  who  are  prone  to  drink  raw  spirits 


HAIRDRESSERS  125 

after  much  exposure  to  the  open  air,  the  skin  now  begins 
to  thicken,  and  perhaps  to  sprout  into  little  lobules  and 
bulbs  and  knobs  of  fat.  But  there  are  unfortunate  people 
who  never  touch  alcohol  at  all  who  get  rosacea  as  a  result 
of  chronic  indigestion,  or  again  it  may  be  a  personal  pe- 
culiarity, inherited  from  the  parents.  Even  well-brought 
up  women  get  rosacea  from  exposure  to  the  air  and  feeble- 
ness of  circulation. 

The  treatment  is  not  hopeless  if  the  patient  will  go  with- 
out alcohol  for  always,  and  give  up  tea  and  coffee  until 
cured.  The  doctor  must  be  consulted  to  put  the  patient's 
stomach  in  good  order.  After  that,  the  sufferer  from  a  red 
nose  is  to  take  a  5-grain  tabloid  of  ichthyol  before  breakfast 
and  before  retiring  to  bed.  After  a  fortnight  the  dose  is 
to  be  increased  to  eight  grains,  and  after  three  weeks  to  ten 
grains,  until  the  case  is  cured.  This  is  to  be  combined  with 
the  local  application  of  alkaline  spirits  of  soap  to  the  nose 
and  cheeks  at  bedtime,  or  by  using  ichthyol  ointment. 

Gumboil. — A  spot  of  inflammation,  leading  on  to  the  for- 
mation of  an  abscess,  and  commencing  near  the  fang  of  a 
decayed  tooth.  The  gum  is  a  very  dense,  hard  structure, 
and  the  growth  of  the  abscess  causes  great  pain;  it  forms 
a  red,  tender  swelling  on  the  gum  and  may  burst  alongside 
the  tooth,  or  through  the  gum,  or  in  the  cheek.  Give  a 
brisk  purgative  such  as  a  dose  of  salts  and  senna,  and  get 
a  dentist  to  open  up  the  hollow  tooth  or  to  lance  the  gum; 
if  this  is  not  desired,  some  slight  relief  may  be  gained  from 
holding  hot  water  in  the  mouth,  or  applying  a  few  drops 
of  laudanum  and  spirit  of  camphor  on  cotton-wool  to  the 
gum,  or  by  hot  poultices  to  the  cheek.  Gumboils  often 
recur  and  when  this  happens  removal  of  the  tooth  is  the 
only  remedy. 

Hairdressers,  Hints  to. — In  some  parts  of  Europe  the 
government  authorities  compel  all  hairdressers  and  barbers 
thoroughly  to  disinfect  all  instruments  and  brushes  imme- 
diately after  use. 

If  such  excellent  regulations  were  in  force  in  this  coun- 
try we  should  soon  hear  no  more  of  diseases  contracted  by 
people  in  hairdressers'  shops.  Among  the  diseases  spread, 
partly  in  ignorance,  partly  by  lack  of  thoroughness  in 
cleanly  precautions,  by  hairdressers  and  barbers  among 
their  customers,  are  Barbers'  Itch  (which  see),  different 
forms  of  ringworm,  boils,  acne,  itch,  impetigo  and  others. 


126  HAIRDRESSERS 

Of  course,  the  self-respecting  barber  in  this  country  also 
uses  disinfectants,  and  is  as  thorough  in  his  cleanliness  as 
he  knows  how  to  be ;  but  sometimes,  from  ignorance  of  the 
diseases  in  question,  he  does  not  know  how  properly  to 
guard  against  them.  We  have  therefore  drawn  up  a  few 
rules  for  the  guidance  of  hairdressers  in  this  matter  of 
the  hygiene  of  the  toilet. 

(1)  Everything   in   the   shop    ought   to   be   thoroughly 
cleaned  at  the  beginning  of  the  working  day.     Not  only 
must  the  rooms  be  swept  out  with  a  broom  (that  only  re- 
distributes some  of  the  small  dust  and  hair  on  the  floor)  ; 
but  a  mop  ought  to  be  used  after  the  broom,  and  the  mop 
ought  to  be  kept  in  a  bucket  containing  a  lotion  made 
thus: — Dissolve  one-eighth  grain  soloid  of  corrosive  subli- 
mate in  a  quart  of  water.     Renew  this  lotion  twice  a  week 
at  least,  and  use  it  on  the  mop  for  disinfecting  the  dust 
on  the  floor  everywhere.     In  addition  to  this,  all  seats  and 
chairs  and  chair-backs  should  be  sponged  thoroughly  with 
this  powerful  germicide  lotion,  and  all  basins,  tubes,  and 
taps  also. 

(2)  All  the  barber's  assistants  should  wear  white  cotton 
washable  jackets  with  short  sleeves,  and  no  frayed  cuffs 
beneath.     All  assistants  should  be  required  to  wash  their 
hands  and  arms  in  carbolic  soap  5  per  cent.,  and  to  keep 
the  nails  short  and  polished  and  clean.     Nails  should  never 
be  cleaned  with  a  knife  or  steel  pick,  but  with  a  nailbrush 
which  is  kept  always  in  a  little  tray  of  lotion. 

(3)  Shaving  brushes  are  peculiarly  liable  to  convey  con- 
tagious diseases  unless  kept  quite  clean.     They  ought  to  be 
washed  in  a  corrosive  sublimate  lotion  after  every  using. 
Trays,   like  those  used  by  photographers  for   developing 
plates,  should  stand  on  the  sideboard,  half-full  of  boric 
lotion,  and  all  scissors,  clippers,  and  razors  ought  to  lie  in 
the  lotion  until  just  before  use.     Boric  lotion   does  not 
rust  steel  instruments.     It  is  made  by  dissolving  a  boric 
acid  carton  in  a  pint  of  boiling  water.     Some  hairdressers 
dip   the  razor   into   hot   water  just  before   use,   but  the 
water  must  be  boiling  if  it  is  to  be  of  any  special  antiseptic 
use. 

(4)  The  soap  used  is  important,  but  the  choice  of  it  must 
be  left  to  the  individual  barber.     Be  careful  only  not  to 
use  the  same  cake  of  soap  for  a  spotty  chin  and  a  healthy 
skin  in  succession.     The  most  hygienic  way  is  to  use  one  of 


HAIR,  CARE  OF  127 

the  soap-powder  preparations,  so  as  to  have  absolutely  fresh 
soap  for  each  customer. 

(5)  After  shaving,  the  razor  should  be  wiped  on  a  wash- 
able india-rubber  slab  or  tray,  as  is  already  done  in  many 
places.     A  spotty  chin  should  then  be  sprayed  with  the 
weak  corrosive  sublimate  lotion  above  mentioned,  with  a 
few  drops  of  scent  in  it,  and  a  small  square  serviette  may 
be   used   to   wipe   dry.     The   powder   afterwards   applied 
should  be  made  of  equal  parts  of  talc,  zinc  oxide,   and 
starch. 

(6)  Combs  used  after  hair-cutting  should  be  disinfected, 
and  brushes  should  be  washed  with  5  per  cent,  carbolic  soap. 

(7)  Hairdressers   who    adopt   these   thorough   measures 
should  take  care  to  advertise  the  fact  in  their  windows. 

Hair,  How  to  take  Care  of. —  (1)  Use  little  grease  or  po- 
matum on  your  hair,  unless  your  health  is  not  good  and 
the  hair  is  brittle  and  splits  at  the  ends.  Then  you  can 
use  a  little  pure  olive  oil  which  is  to  be  rubbed  on  to  the 
scalp  and  not  just  smeared  over  the  hair. 

(2)  No  animal  fat  or  lard  or  lamb's- wool  ointment  should 
be  used  on  the  scalp.     It  only  irritates  the  skin  as  it  be- 
comes rancid,  and  causes  scurf. 

(3)  Don't  wash  the  head  with  frequent  irrigations  of 
cold  water.     Nothing  so  soon  makes  the  hair  gray  and 
scanty. 

(4)  To  wash  the  head,  make  a  lotion  of  a  teaspoonful  of 
ammonia  to  a  quart  of  hot  rain  water,  and  add  two  table- 
spoonfuls  of  soft  soap.     A  lump  of  carbonate  of  soda  will 
do  instead  of  the  soft  soap  if  you  prefer  it.     After  washing 
the  hair,  dry  it  very  thoroughly  on  a  rough  towel — not  a 
Turkish  bath  towel,  full  of  fluff.     If  your  hair  is  fair,  that 
method  will  suit  it  well.     But  if  your  hair  is  dark,  use  the 
yolk  of  an  egg  beaten  up  with  borax  and  rain  water. 

(5)  For  thin,  scanty  hair. — Quinine  sulphate,  1  drachm; 
dilute  sulphuric  acid,  15  minims ;  rectified  spirit,  2  ounces ; 
rose  water,  8  ounces — mix,  and  add  glycerin,  2  drachms; 
— mix  and  shake  well.     Use  this  lotion,  rubbed  in  the  scalp, 
twice  a  day. 

(6)  For  thin,  scanty  dark  hair. — Take  of  good  black  tea- 
leaves,  1  ounce;  add  boiling  water,  1  pint.     Infi  se  in  a 
teapot.     Leave  to  cool.     Strain  off  the  infusion,  <md  add 
to  it,  Jamaica  rum,  3  fluid  ounces.     Rub  some  into  the  roots 
of  the  hair  with  a  piece  of  rag,  morning  and  evening. 


128  HAIR,  CAKE  OF 

(7)  The  color  of  hair  is  due  to  mineral  pigments.     Very 
fair  hair  contains  magnesia,  and  fair  hair  often  remains 
unchanged,  even  in  old  age.     Brown  and  chestnut  locks 
contain  sulphur,  and  a  little  iron;  black  hair  pigment  is 
rich  in  iron.     Gray  and  white  hair  have  no  iron  and  very 
little   sulphur.     Therefore,   most   hair  restorers  and  dyes 
contain  iron  and  sulphur.     But  all  ordinary  shop-sold  dyes 
are  apt  to  be  unsafe,  and  may  have  poisonous  minerals  in 
them  which  will  at  last  make  the  hair  and  scalp  decay. 

There  is,  in  fact,  no  really  satisfactory  hair  dye,  as  far 
as  we  know. 

(8)  Greasy  lank  hair  may  be  made  somewhat  dryer  and 
curlier  by  the  use  of  such  lotion  as  this: — Bicarbonate  of 
soda  powder,  2  drachms;  borax  powder,  2  drachms;  eau- 
de-cologne,  1  fluid  ounce ;  rectified  spirit,  2  ounces ;  tincture 
of  cochineal,  4  fluid  drachms;  distilled  water,  16  ounces. 
(Mix  and  shake.) 

(9)  For  dry,  stubby  hair,  instead  of  grease  or  pomade, 
use: — Eau-de-cologne,  8  ounces;  tincture  of  cantharides,  1 
ounce;  oil  of  English  lavender,  15  drops;  oil  of  rosemary, 
20  drops.     (Make  a  lotion  to  be  rubbed  well  into  both  hair 
and  scalp.) 

(10)  After  an  illness  your  hair  may  come  out  in  hand- 
fuls.     To  remedy  this,  cut  it  quite  short  and  keep  it  so  for 
a  year,  using  the  lotion  given  above  in  paragraph    (5). 
This  plan  enables  both  air  and  light  to  get  down  to  the 
scalp  and  enables  you  to  employ  friction  of  the  scalp  with 
a  wire  brush.     Use  no  grease. 

(11)  Shampoo,  for  scurfy  heads : — Yolk  of  an  egg,  a  pint 
of  rain  water,  an  ounce  of  spirit  of  rosemary.     (Mix  and 
warm  before  using.) 

(12)  "Silver  hairs  among  the  gold." — A  few  gray  hairs 
appearing  in  a  youth  show  that  the  scalp  is  badly  nourished. 
Get  the  doctor  to  prescribe  you  an  iron  tonic,  and  use  cheap 
claret  as  a  weekly  head  wash. 

(13)  To  make  the  hair  curly. — All  shop-sold  prepara- 
tions  for  this  purpose  are  risky  to  use.     The  following 
"curling   fluid"   is   free   from   objections: — Carbonate   of 
potassium,  12  grains;  warm  water,  made  soapy,  one  pint. 
(Disso]ve. — Stir  up  into  a  froth,  damp  the  hair  brush  with 
it  and  brush  the  hair  thoroughly  at  bedtime,  with  the  wet 
brush.     Then  curl  up  the  hair  on  rollers  of  wire  and  kid 
[such  as  all  first-rate  hairdressers  keep  for  sale].     In  the 


HANGING  129 

morning  the  curliness  of  the  hair  will  outlast  even  rainy 
weather  to  some  extent.) 

Never  use  crimping-irons,  they  only  destroy  the  hair  at 
last. 

Hair,  Loss  of.—  (See  "Baldness.") 

Hairs,  Superfluous. — Superfluous  hairs  on  the  faces  of 
women  are  a  fruitful  source  of  profit  to  skin  doctors, 
beauty  doctors  (so  called),  chemists,  and  hairdressers. 
Electrolysis  (or  the  removal  of  hairs  by  electricity)  can 
only  be  done  by  specialists.  Perhaps  as  many  as  twenty 
hairs  may  be  removed  at  one  sitting.  There  is  only  one 
class  of  chemicals  which  may  help  in  the  matter — caustic 
alkalies,  in  combination  with  sulphides,  and  these  are  dan- 
gerous. A  paste  is  made  thus: — Quicklime,  16  oz. ;  pearl- 
ash,  2  oz. ;  liver  of  sulphur,  2  oz.  These  are  mixed  and 
finely  powdered,  and  enough  water  is  added,  as  required, 
to  make  a  paste.  The  paste  is  spread  thickly  on  the  skin 
for  three  minutes,  then  it  is  scraped  off  with  a  bone  paper 
knife,  and  cold  cream  is  applied  instead.  The  lip  or  chin 
thus  treated  will,  perhaps,  itch,  grow  red,  and  smart.  The 
epidermis  is  removed.  The  hairy,  downy  growth  is  all  gone. 
But  the  hair  bulbs,  deep  down  in  the  skin,  remain,  and  later 
on  a  fresh  crop  of  hair  comes  up,  as  if  nothing  had  been 
done.  A  German  physician  has  made  a  liquid  depilatory. 
Here  it  is: — Tincture  of  iodine  (1  in  10),  half  a  drachm; 
Venice  turpentine,  1  drachm ;  castor  oil,  1%  drachms ;  recti- 
fied spirit,  1%  oz. ;  collodion,  6  oz. — Mix.  This  is  painted  on 
the  part  at  night,  and  next  morning  the  film  is  peeled  off; 
and  the  hairs  if  they  behave  themselves  properly,  come  up 
by  the  roots.  But  sores  may  be  left,  and  they  are  difficult 
to  heal.  No  one  should  try  such  experiments  except  under 
skilled  advice. 

Hanging. — If  ever  you  come  across  a  person  who  has 
hanged  himself  or  herself,  or  who  has  been  hanged  by 
someone  else — that  is,  if  ever  you  see  a  body  hanging  by 
the  neck — get  a  knife  or  scissors  and  cut  the  body  down. 
Don't  lose  your  presence  of  mind;  don't  be  foolish  enough 
to  stand  horror-stricken,  or  to  rush  away  and  whisper  the 
awful  fact  to  somebody  else.  This  kind  of  foolishness  is, 
unfortunately,  common  enough  in  cases  of  hanging,  but  let 
the  reader  of  this  book  be  more  sensible. 

Cut  the  body  down. —  (Many  a  criminal  or  highwayman 
in  the  old  days  was  cut  down  by  his  friends  and  brought 


130  HAY  FEVER 

back  to  life  again,  even  after  half-an-hour 's  suspension.) 
When  you  have  cut  it  down,  loosen  the  noose  round  the 
neck  and  perform  "artificial  respiration,"  as  described 
under  "Drowning."  (See  "Drowning.") 

If  the  neck  is  not  broken  you  can  probably  restore  the 
patient  back  to  life  again. 

Hangnail. — This  means  a  sore  finger  from  irritation  set 
up  by  a  little  tag  of  skin  peeling  off  near  one  of  the  nails. 

When  one  is  in  a  weak,  unhealthy  condition  the  skin  of 
the  fingers  becomes  liable  to  fester  whenever  any  little 
scratch  occurs;  any  little  raw  spots  get  infected  with  dirt 
and  become  acutely  painful.  To  obtain  a  cure  clean  the 
part  very  thoroughly  with  soap  and  hot  water,  and  then 
with  clean  water,  dry  it,  and  paint  the  spot  with  flexile 
collodion,  or  the  liquid  called  "new  skin";  under  this  coat- 
ing the  little  ulcer  will  soon  heal  up ;  after  this  rub  vase- 
line into  the  skin  of  the  fingers  every  night  for  a  week. 

Harelip. — This  is  a  notch  or  cleft  in  the  upper  lip  on  one 
side  of  the  middle  line,  caused  by  a  lack  of  proper  develop- 
ment of  the  face.  Sometimes  there  is  a  notch  on  the  other 
side  of  the  middle  line  as  well,  leaving  a  central  flap  of 
lip  (double  harelip).  There  may  be,  in  the  same  person,  an 
incomplete  development  of  the  palate  as  well,  called  cleft 
palate. 

Treatment. — A  very  slight  notch  in  the  lip  may  be  op- 
erated on  a  few  weeks  after  birth.  Of  course,  there  is  no 
cure  for  the  deformity,  except  a  plastic  operation.  Cleft 
palate,  if  complete,  can  also  be  cured  by  operation,  and 
this  ought  to  be  done  when  the  child  is  about  18  months 
old.  The  deformity  will  interfere  with  learning  to  speak, 
and  until  harelip  is  cured  the  child  cannot  suck  properly. 

Hay  Fever. — This  refers  to  a  peculiar  catarrh  of  the  nose 
and  eyes  affecting  some  people  from  May  or  June  to  the 
latter  part  of  July  (rose  cold)  or  from  the  latter  part  of 
August  to  the  first  frost  (autumnal  catarrh). 

It  runs  in  families,  especially  gouty  families,  and  affects 
chiefly  men  of  high  intellectual  powers.  It  is,  in  fact,  a 
neurosis  or  functional  nervous  disease. 

Signs. — The  eyes  and  nose  water,  the  patient  sneezes,  has 
a  hard  cough,  and  attacks  of  shortness  of  breath.  But 
there  is  no  f everishness.  The  attack  'may  last  for  several 
weeks,  though  a  change  of  air  and  scene,  especially  to  a 
barren  and  non-fertile  district,  will  often  effect  a  cure. 


HEADACHE  131 

Treatment. — In  the  first  place,  a  person  liable  to  hay 
fever  must  avoid  the  fields  during  the  summer.  A  seaside 
place  is  generally  the  best  to  go  to,  provided  it  is  bare 
and  there  are  no  forests  near. 

The  only  medicine  of  much  service  is  Dunbar's  pollantin, 
a  few  drops  of  which  are  to  be  instilled  into  the  eyes  every 
morning  during  the  attack.  Lately,  supra-renal-extract 
spray,  5  per  cent.,  has  been  used  to  spray  nose  and  throat 
with  a  good  deal  of  success  in  these  cases.  A  solution  of 
quinine  used  as  a  nose  spray  is  also  useful. 

Headache  (Varieties  of). — Headaches  may  be  due  to 
dozens  of  different  causes.  No  doubt  the  reader  cares  very 
little  about  that — what  he  or  she  wants  is  to  know  how  to 
cure  a  headache!  But  there  is  no  royal  road  to  anything 
in  life,  and  certainly  not  to  the  curing  of  a  complaint. 
That  is  why  doctors  are  real  necessities,  in  spite  of  the 
quacks  and  their  cure-alls.  The  man  who  analyzes,  and 
studies  and  builds  up  personal  experience  of  disease,  is  the 
only  man  whose  opinion  is  worth  anything  in  these  matters ; 
and  every  doctor  will  tell  you  that  there  is  no  royal  road 
to  a  cure.  But  he  who  studies  the  possible  causes  of  head- 
ache, and  then  applies  his  remedy,  has  some  chance  of  cur- 
ing the  complaint.  A  dyspeptic  headache  may  be  known 
by  the  pain  being  worse  after  food,  and  by  its  being  accom- 
panied by  costiveness,  acidity,  and  a  feeling  of  sickness. 
The  headache  of  the  ancemic  girl  occurs  in  girls  who  are 
pale  or  yellow,  and  have  pale  lips,  and  suffer  from  palpi- 
tation of  the  heart.  Hysterical  headaches  are  usually 
worse  at  certain  times,  and  are  generally  confined  to  one 
special  part  of  the  head.  Such  headaches  are  said  to  be 
like  nails  driven  into  the  temples.  Rheumatic  or  neuralgic 
headaches  are  generally  diffused  over  the  whole  head;  the 
scalp  is  tender,  and  there  are  rheumatic  pains  in  other  parts 
or  joints.  Sick  headaches  are  ushered  in  by  flashes  of  light 
in  the  eyes,  dizziness,  or  temporary  blindness.  After  the 
headache,  which  is  generally  quite  local,  comes  a  feeling 
of  nausea  or  sickness.  The  headache  of  the  person  who 
suffers  from  neurasthenia,  or  nerve  exhaustion,  is  generally 
a  feeling  of  weight  on  Jthe  top  of  the  head,  and  is  attended 
with  a  good  deal  of  confusion  of  thought.  The  temper  is 
irritable,  and  the  patient  is  sleepless.  There  are  many 
other  varieties  of  headache,  some  connected  with  actual 
brain  disease.  But  it  is  impossible  to  go  into  those  in  this 


132  HEADACHE 

article.  As  to  cures,  they  must  obviously  depend  upon  the 
cause  of  the  complaint.  Anaemic  and  hysterical  people 
will  always  be  subject  to  headaches,  until  the  anaemia  is 
cured  by  large  and  continued  doses  of  iron;  and  the  hys- 
teria is  improved  by  marriage  or  by  a  little  severe  treat- 
ment (see  also  "Hysteria"). 

This  subject  seems  so  important  that  we  shall  give  a 
more  detailed  account  of  a  few  of  the  different  kinds  of 
headache,  and  some  prescriptions.  We  have  already 
warned  the  reader  that  he  must  study  to  find  out  the  cause 
of  the  headaches  before  taking  remedies;  and  we  may  add 
that  many  of  the  " headache  powders"  of  the  patent  medi- 
cine market  are  either  dangerous  or  useless. 

I. — Migraine  or  Sick  Headache. — These  headaches  occur 
periodically.  They  come  on  regularly  at  certain  intervals, 
or  else  occur  quite  unexpectedly  without  traceable  cause. 
The  attacks  may  begin  at  any  period  of  life  and  affect  one 
side  of  the  head  only.  Some  patients  feel  chilly  and  irrita- 
ble and  depressed  before  an  attack ;  then  come  disturbances 
of  vision — spots  and  flashes  of  light,  zigzag  figures  and 
blurring  of  sight,  even  blindness  for  a  time,  especially 
blindness  of  one  half  of  the  field  of  vision.  The  patient 
seeks  a  dark  room  and  a  warm  corner.  Then  comes  a  vio- 
lent headache,  which  lasts  about  an  hour  or  more,  and  is 
followed  by  sickness  and  nausea  and  yawning.  When  he 
has  vomited  several  times,  and  a  sour  liquid  has  come  up, 
the  headache  ceases  and  the  sufferer  falls  asleep.  Severe 
forms  may  last  two  days.  The  disease  is  frequently  in- 
herited, especially  from  gouty  parents. 

The  treatment  by  diet  is  unsatisfactory;  the  most  ab- 
stemious sometimes  have  migraine.  Between  the  attacks, 
especially  if  they  are  regular,  it  is  a  good  plan  to  take 
five  grains  of  butyl-chloral  and  twenty  grains  of  sodium 
bromide  thrice  daily  for  three  days  before  the  attack  is 
expected.  Many  people  keep  tabloids  of  antipyrin  at  home, 
and  swallow  one  when  they  feel  headachy.  But  this  is  to 
be  condemned,  because  the  drug  lowers  the  heart.  Phen- 
acetin  is  better;  and  caffeine  is  better  still;  during  attacks 
take  one  grain  with  a  little  sugar  of.  milk  every  hour  until 
recovered. 

II. — Ancemia,  Headache  due  to. — The  pain  in  this  type 
of  headache  is  generally  more  or  less  continuous,  and  affects 
sometimes  the  forehead,  sometimes  the  back  of  the  head,  and 


HEAKT  DISEASE  133 

sometimes  the  top.  Bodily  and  mental  exertion  make  it 
worse.  The  patient  is  generally  costive,  drowsy,  listless, 
and  sleeps  badly.  Of  course  the  anaemia  itself  must  be 
dealt  with  by  the  doctor.  Tea  and  coffee  are  useful  reme- 
dies, but  alcohol  does  harm.  If  the  patient  is  hysterical 
as  well  as  angemic,  let  her  take  a  one-grain  pill  of  valerianate 
of  zinc  and  one-sixtieth  grain  of  phosphorus  twice  a  day, 
for  a  month  at  a  time,  and  ten  to  twenty  grains  of  sodium 
bromide  at  bedtime,  occasionally,  to  produce  sleep. 

III. — Congestive  Headaches  are  due  to  over-indulgence 
in  food  or  drink;  sluggish  liver;  the  change  of  life  (which 
see),  and  heart  disease.  The  blood  vessels  throb,  the  face 
flushes,  the  pain  gets  worse  when  lying  down,  and  there  is 
giddiness.  These  headaches  cannot  be  cured  by  drugs, 
except  those  drugs  which  relieve  the  causes  of  the  condition. 
But  until  the  doctor  comes,  and  until  the  general  state  of 
health  is  improved,  purgative  medicines  will  always  give 
relief. 

Health  Resorts.—  (See  "Climate  for  Invalids.") 

Heartburn  is  a  burning  sensation,  sometimes  amounting 
to  pain,  passing  up  along  the  food  pipe  or  gullet  from  the 
stomach  to  the  back  of  the  throat.  Sometimes  mouthfuls 
of  an  acid  fluid  are  brought  up  at  the  same  time.  It  is 
caused  by  Acidity  (which  see),  and  the  return  of  acidified 
food  from  the  stomach.  (See  "Indigestion.") 

Heart  Disease. — The  heart,  which  is  situated  in  the  chest, 
between  the  lungs,  a  little  to  the  left  of  the  middle,  is  the 
most  important  organ  of  the  body.  It  is  formed  of  red 
flesh  or  muscle,  and  contains  four  cavities,  through  which 
the  blood  is  constantly  flowing  from  the  veins,  and  on  into 
the  arteries,  to  nourish  the  whole  of  the  tissues  of  the  body. 
The  heart  is  in  a  constant  state  of  contraction  and  relaxa- 
tion, which  continues  as  long  as  life  lasts;  even  its  mo- 
mentary stoppage  causes  a  partial  death,  called  fainting. 
In  order  to  maintain  health,  the  heart  must  be  in  good 
order,  and  whenever  any  part  of  the  heart  is  injured  by 
disease,  there  are  sure  to  be  some  symptoms  of  ill-health, 
as  well  as  some  defect  in  the  circulation  of  the  blood. 

Diseases  of  the  heart  may  be  considered  in  two  groups — 
functional  and  organic;  the  first  including  all  cases  of 
wrong  action  of  the  heart  without  disease  or  deformity  of 
the  structural  anatomy  of  the  heart;  the  second  includes 
all  defects  of  the  walls  of  the  heart,  all  faults  in  the 


134  HEART  DISEASE 

muscular  texture,  and  all  imperfections  of  the  many  valves 
within  the  heart.  All  actual  organic  faults  are  incurable, 
but  some  relief  may  often  be  given  by  suitable  treatment. 
On  the  other  hand,  functional  heart  diseases  are  often  tem- 
porary; they  may  come  and  go  with  variations  in  the 
constitution. 

The  most  common  cause  of  functional  heart  symptoms 
is  the  state  called  Anaemia,  or  bloodlessness,  which  means 
that  the  blood  is  too  weak  and  watery.  It  is  shown  by 
pallor  of  the  cheeks,  and  lips,  and  ears,  palpitation  on 
slight  exertion,  a  state  of  breathlessness,  and  a  tendency  to 
fainting.  Hysterical  women  also  suffer  from  this  form  of 
heart  disease,  and  it  is  often  seen  in  women  past  middle 
age.  Drunkards  are  liable  to  it,  and  an  excessive  use  of 
tobacco  may  cause  a  feeling  of  weakness,  giddiness,  trem- 
bling, and  faintness  due  to  an  unsteady  cardiac  action. 
Patients  who  are  weak  after  a  serious  illness,  or  after  an 
accident,  have  almost  always  a  temporary  loss  of  the  strong, 
regular  action  of  the  heart  which  is  so  necessary  to  per- 
sonal comfort.  Persons  with  feeble  anaamic  hearts  often 
have  puffy  ankles  at  night  and  swollen  eyelids  in  the  morn- 
ing. The  pulse  is  generally  too  quick,  but  too  small, 
thready  and  feeble ;  there  may  be  a  dull  pain  in  the  chest, 
and  very  often  there  is  an  inability  to  sleep  lying  on  the 
left  side;  in  some  cases  there  are  headaches,  giddiness, 
noises  in  the  ears,  and  flushings  of  the  face.  In  these  cases 
a  doctor  must  try  simple  remedies,  in  the  hope  that  there 
may  be  no  organic  disease,  for  the  sounds  heard  by  the 
stethoscope  much  resemble  those  of  real  valvular  disease. 

I. — Organic  heart  disease. — The  several  forms  of  or- 
ganic cardiac  disease  are  due  to  actual  faults  in  the  heart's 
muscles,  and  the  valves  within  the  heart.  In  some  cases 
these  faults  are  present  at  birth,  and  continue  during  life, 
but  in  other  cases  the  mischief  arises  from  over-strain,  or 
from  rheumatic  fever,  or  from  fatty  degeneration  of  the 
muscles.  A  wasting  or  atrophy  of  the  heart  is  also  known, 
and  an  over-growth  or  chronic  enlargement  of  the  heart  is 
often  present  as  a  secondary  result  of  obstructions  to  the 
circulation  of  the  blood,  as,  for  example,  from  chronic 
alcoholic  hardening  of  the  kidney.  Still  another  and  very 
fatal  form  of  heart  disease  is  called  dilatation,  in  which 
the  heart  is  larger,  but  not  heavier;  and  this  is  due  to  a 
dilating,  bulging,  or  enlargement  of  the  cavities,  while  the 


HEART  DISEASE  135 

walls  get  thinner  and  weaker.  This  disease  often  leads  to 
sudden  death  from  a  faint,  or  from  spasm  of  the  heart. 
There  are  four  valves  within  the  heart,  through  which  the 
circulating  blood  is  constantly  passing,  and  these  have  to 
open  and  close  about  70  times  in  each  minute  of  our  lives. 
Whenever  the  valves  are  out  of  order,  or  deformed  by  such 
inflammation  of  them  as  occurs  with  rheumatism,  there  is 
more  or  less  disturbance  of  circulation,  leading  to  various 
symptoms,  such  as  pain,  breathlessness,  cough,  palpitation, 
fainting  and  dropsical  swellings  of  the  legs  and  face,  all 
due  to  the  effects  of  the  valve  disease  on  the  heart  walls. 

II.  Valvular  diseases,  which  are  mostly  due  to  attacks 
of  inflammation,  caused  by  rheumatic  poison,  of  the  deli- 
cate membrane  lining  the  cavities  within  the  heart,  are  of 
two  sorts — first,  those  which  obstruct  and  delay  the  blood- 
flow  through  the  valves,  and,  secondly,  those  which  prevent 
the  correct  closing  of  the  valves  at  each  contraction  of  the 
heart.     These  valvular  troubles  due  to  inflamed  membranes 
are  most  commonly  found  to  originate  during  the  course  of 
acute  rheumatism,  during  which  the  large  joints  of  the 
limbs  are  most  affected.     Another  form  of  valvular  mischief 
arises  in  late  middle  life  from  the  deposit  of  chalky  flakes 
and  bony  layers  in  the  structures  forming  the  valves;  the 
result  is  that  the  valves,  which  in  youth  and  health  are 
delicately  soft  and  elastic,  become  hard  and  brittle,  and 
are  liable  to  lead  to  sudden  fain  tings  and  unexpected  death. 
The  form  of  heart  disease  in  any  patient  is  partly  judged 
from  the  symptoms,  and  partly  from  the  sounds  arising 
from  the  heart's  action,  which  can  be  heard  outside  the 
chest  by  means  of  the  stethoscope  in  the  hands  of  a  skilled 
physician.     Skill  in  this  process  is  not  easy  to  acquire,  and 
when  gained  it  needs  constant  use,  for  the  ordinary  person 
hears  nothing  but  confused  and  very  slight  sounds  when  he 
applies  the  stethoscope  to  a  chest. 

III.  The  doctor's  examination  of  the  heart. — The  in- 
troduction of  the  use  of  the  stethoscope,  which  is  a  wooden 
or  metallic  tubing,  having  at  one  end  an  ear  piece  and  at 
the  other  a  chest  piece,  has  very  much  increased  the  power 
of  the  physician  to  diagnose  or  discover  the  nature  of  a 
case  of  heart  disease.     This  instrument  is  now  also  made 
of  india-rubber  tubes,  for  use  with  either  one  or  both  ears. 
By  its  means  the  sounds  made  in  the  lungs  by  the  breathing 
are  also  heard,  and  when  listening  to  a  chest  in  certain 


136  HEATING 

positions  both  lung  and  heart  sounds  are  heard  at  once,  so 
that  experience  and  skill  are  needed  to  come  to  correct 
conclusions  as  to  the  origin  and  meaning  of  chest  sounds. 
Diseases  of  the  valves  of  the  heart  give  rise  to  sounds  called 
murmurs.  The  study  of  these  murmurs  is  by  no  means 
easy,  and  it  is,  unfortunately,  true  that  some  forms  of  a 
very  serious  heart  disease  do  not  produce  any  of  these  curi- 
ous noises.  Another  mode  of  discovering  heart  diseases  is 
by  the  process  called  percussion,  or  rapping  the  chest  sur- 
face and  noting  the  clearness  or  dullness  of  the  musical  note 
produced.  By  this  means  a  physician  can  tell  how  large  a 
heart  is,  and  whether  or  not  it  is  displaced  from  its  correct 
position  between  the  two  lungs.  A  doctor  also  gains  a 
knowledge  of  the  heart's  action  by  merely  looking  at  and 
gently  feeling  the  chest  surface.  By  these  means  he  notices 
the  place  and  force  of  the  heart's  beat.  The  apex,  or 
pointed  lower  end  of  the  heart,  should  tap  against  the  chest 
on  the  left  side  of  the  breastbone,  about  three  inches  from 
it,  and  between  the  fifth  and  sixth  ribs;  its  action  should 
be  regular  as  to  intervals,  and  regular  also  as  to  force. 
Nervous  people,  however,  will  be  found  for  a  few  minutes 
to  have  an  irregular  throbbing  action  of  the  heart,  called 
palpitation,  when  a  doctor  tries  to  examine  it.  This  alone 
is  no  proof  of  heart  disease,  but  only  of  nervousness.  At- 
tacks of  palpitation,  or  heart-throbbing,  are  a  frequent 
symptom  of  heart  disease,  possibly  only  due  to  a  weak,  or 
fatty,  or  nervous  state  of  that  organ,  and  are  not  a  proof 
of  actual  structural  disease,  nor  of  valvular  mischief. 
Shortness  of  breath  and  panting  on  exertion  are  also  signs 
that  the  heart  is  not  in  good  order.  The  pulse,  as  it  is 
felt  conveniently  at  the  wrist,  gives  valuable  indications 
of  the  rate  of  the  heart's  action  and  its  strength.  When  it 
is  irregular,  and  especially  when  it  occasionally  misses  a 
beat,  medical  advice  should  be  sought. 

Heating. — There  is  perhaps  no  department  of  domestic 
economy  about  which  greater  ignorance  is  displayed  than 
the  warming  of  houses.  Among  the  poorer  classes  more 
especially,  this  ignorance,  combined  with  more  or  less  care- 
lessness, leads  to  the  most  reckless  waste  in  the  consump- 
tion of  coal,  even  when  poverty  necessitates  its  being  pur- 
chased at  the  cost  of  considerable  deprivation  in  other  di- 
rections. Poorly  constructed  fireplaces  have  been  to  blame 
for  this.  In  recent  years  some  improvement  has  been  ap- 


HEATING  137 

parent,  but  even  now  we  have  not  seen  the  last  of  the  hide- 
ous, hollow-backed  iron  grates. 

Closely  associated  with  the  comfort,  efficiency  and 
economy  of  heating  is  the  subject  of  humidity  of  the  air. 
Humidity  is  harmful  not  only  if  too  high  but  also  if  too 
low.  Room  temperature  should  be  maintained  at  65  to  70° 
F.  When  heated  air  is  maintained  at  a  temperature  of 
72°  F.  the  humidity  is  usually  about  24%. 

If  now  the  humidity  is  artificially  increased  to  50%  the 
body  feels  the  same  sense  of  comfortable  warmth  if  the 
temperature  is  only  65°  F. ;  and  in  this  reduction  of  tempera- 
ture there  is  not  only  a  saving  in  fuel  cost  of  12%%,  but 
the  occupants  of  the  rooms  have  increased  freedom  from 
influenza,  catarrh,  coughs,  and  colds. 

Overheated  air  which  lacks  moisture  subtracts  it  from 
any  surface  in  the  room — the  skin,  hair,  and  mucous  mem- 
branes of  a  person — hence  the  discomfort.  The  faults  of 
most  heating  apparatus  are  mainly  due  to  their  super- 
heating the  air,  and  to  their  lack  of  any  provision  for 
ventilation. 

The  principal  methods  of  heating  are — open  fires,  closed 
fires  and  stoves,  hot  air  and  pipes  containing  hot  water 
or  steam.  One  of  the  best  methods  is  that  known  as  the 
"plenum"  system. 

Open  fires  carry  off  large  volumes  of  air  besides  their 
own  products  of  combustion,  stoves  only  a  little ;  hot  pipes 
not  at  all;  while  fender  stoves  not  only  do  not  ventilate 
but  add  to  the  impurity  of  the  air. 
Grates  or  Open  Fireplaces: — 

These  are  excellent  aids  to  ventilation,  extracting  from 
10,000  to  20,000  cubic  feet  of  air  per  hour  through  the 
chimney.  If,  however,  pure  air  is  not  provided  to  meet 
the  demand  the  air  of  halls,  kitchens,  cellar  or  water-closet 
is  drawn  upon  with  the  result  that  good  ventilation  is  not 
accomplished.  The  ordinary  fireplace  is  also  extremely 
wasteful  of  fuel,  as  only  12  per  cent,  to  14  per  cent,  of 
the  heat  generated  is  utilized  in  a  room,  the  remainder 
escaping  up  the  chimney.  The  common  experience  in  a 
room  so  heated  is  that  the  person  near  the  fire  is  very  hot, 
while  at  any  distance  from  the  fire  the  room  is  cold. 

Gas  stoves  are  economical  and  cleanly  in  use,  create  no 
smoke  and  can  be  lighted,  extinguished  or  regulated  in 
a  moment. 


138  HEATING 

A  gas  stove  burns  from  ten  to  twenty  or  more  cubic  feet 
per  hour,  therefore  the  amount  of  air  consumed,  which  must 
be  renewed,  is  considerable. 

Stoves  have  their  advantages  and  disadvantages. 

There  is  less  loss  of  heat  than  with  open  fireplaces  or 
grates,  and  the  room  is  more  uniformly  warmed.  The  dis- 
advantages are, — poor  ventilation,  air  which  passes  over 
a  stove  becomes  too  dry,  the  burnt  organic  particles  of 
air  may  give  a  disagreeable  odor  and  carbonic  oxide  gas 
may  escape,  giving  rise  to  headache  and  a  feeling  of  dis- 
comfort. 

Hot  Air  is  advocated  by  some  authorities  as  the  best 
mode  of  warming  houses,  as  well  as  public  buildings. 

This  may  be  done  by  a  basement  furnace  and  conveying 
the  warmed  air  to  all  parts  of  the  house  by  special  channels. 
The  essentials  for  this  form  of  heating  are:  a  brick-lined 
fire  chamber,  an  exhaust  flue  for  foul  air  and  a  supply  of 
fresh  air  from  out-of-doors — not  from  the  cellar. 

Hot  Water  and  Steam  Pipes  are  frequently  employed  for 
warming  houses  as  well  as  offices  and  public  buildings. 
This  system,  if  properly  applied,  is  an  excellent  one,  but 
one  usually  finds,  in  cases  in  which  it  is  in  operation,  that 
all  principles  of  ventilation  have  been  completely  disre- 
garded. The  wholesome  influence  of  the  ordinary  fire- 
place in  changing  the  air  of  the  room  is  lost,  with  the 
result  that  the  same  foul  air,  which  has  been  breathed  for 
hours  on  end,  is  circulating  in  warm  currents  round  the 
room  in  question. 

No  system  of  warming  by  hot  water  or  steam  pipes  is 
admissible,  unless  both  inlets  and  outlets  are  provided  for 
ventilation.  The  best  method  of  introducing  air  into  a 
room  warmed  in  this  manner,  is  by  so  arranging  the  open- 
ings that  the  incoming  air  must  first  circulate  over  the 
hot  pipes.  These  are  known  as  ventilating  radiators.  A 
very  convenient  form  of  such  a  device  is  the  electric  radia- 
tor which  possesses  the  advantage  of  yielding  no  products 
of  combustion  and  producing  heat  which  is  available  im- 
mediately the  current  is  turned  on. 

The  form  of  heating  device  which  is  by  all  means  the 
most  preferable  for  public  and  semi-public  places,  theaters, 
apartment  houses,  museums  and  private  houses,  if  the  ex- 
pense is  not  a  drawback,  is  the  "plenum"  system,  or  the 
indirect  system  of  radiation. 


HEATSTROKE  (STINSTKOKE)          139 

The  out-door  air  is  sucked  in  from  near  the  roof-level 
through  a  large  shaft  into  a  cold-air  room,  where  it  is 
moistened  and  washed  by  a  spray  or  water  curtain,  and 
whence  it  passes  through  a  dust-fitter,  consisting  of  a 
double  layer  of  fine  wire  gauze  or  cloth.  Thence  it  passes 
through  tempering  radiators  and  humidifier  into  the  re- 
volving fan  whence  part  passes  through  a  second  radiator 
to  be  further  warmed, — the  other  part  not  further  warmed 
being  mixed  with  this  warmed  air  and  the  mixture  carried 
through  flues  to  the  rooms. 

By  this  method  the  temperature  and  humidity  of  the 
air  can  be  controlled  by  thermostats  and  humidostats  in 
any  room,  the  air  is  pure  and  clean,  and  circulation  of  air 
is  assured  as  it  is  not  unusual  to  supply  a  million  cubic 
feet  of  air  an  hour  by  this  method. 

By  introducing  into  this  circuit  a  cooling  plant  operated 
by  expansion  of  air,  evaporation  of  liquids  or  the  Carre 
ammonia  process,  rooms  can  be  cooled  in  summer  as  well 
as  they  can  be  heated  in  winter. 

Heatstroke  (Sunstroke) , — When  a  person  is  exposed  to 
a  broiling  sun,  or  to  intense  moist  heat,  the  body  is  apt  to 
become  overheated  and  to  suffer  from  the  results.  Those 
who  drink  alcohol  and  those  who  are  depressed  by  worry 
and  anxiety  are  the  ones  most  liable  to  be  made  ill  by 
exposure  to  great  heat.  Among  women,  laundresses, 
bakers,  and  sempstresses,  in  ill-ventilated,  crowded  rooms, 
and  tight-lacers  are  those  who  are  most  liable  to  heat- 
stroke. 

There  are  three  different  ways  in  which  intense  heat 
may  affect  an  individual: — (1)  The  first  is  called  Heat- 
stroke. The  person  feels  suddenly  sick  and  giddy,  then 
drowsy.  The  skin  is  pale  and  clammy,  the  pulse  is  quick 
and  intermittent,  the  breathing  is  gasping  and  sighing. 
The  sufferer  may  die  of  heart  failure  (syncope).  To  cure 
him,  let  him  lie  down  flat,  give  him  sal  volatile  (a  tea- 
spoonful  in  a  wineglassful  of  water),  or  brandy,  and  rub 
the  hands  and  feet. 

(2)  Heat  apoplexy. — This  looks  just  like  an  attack  of 
apoplexy  (which  see),  occurring  in  a  very  hot  place.  There 
is  unconsciousness  and  there  may  be  fits.  Pump  cold  water 
over  head  and  back,  rub  the  body  with  ice  and  give  a  rectal 
injection  of  cold  water.  The  body  is  intensely  hot  in  this 
form  of  heatstroke.  If  the  patient  doesn't  recover  his 


140  HERNIA 

senses  as  his  body  gets  cooler,  shave  his  scalp  and  put  a  large 
blister  on. 

(3)  The  most  serious  form  of  sunstroke  is  called 
Thermic  Fever.  The  heat  of  the  body  runs  up  to  about 
108°  Fahrenheit  or  more,  and  the  patient  simply  burns 
rapidly  away,  if  you  cannot  save  him,  in  a  day  or  two.  He 
has  great  thirst,  quick  bounding  pulse,  pains  all  over, 
headache,  vomiting  and  gasping  for  breath.  The  body  may 
be  swathed  in  a  sheet  wrung  out  of  cold  water. 

Hernia,  or  Rupture. — This  word  means  the  protruding 
of  an  organ  into  or  through  the  wall  of  the  cavity  to  which 
it  belongs.  Thus,  a  hernia  of  the  lung  is  said  to  be  present 
when  there  is  a  wound  of  the  chest  wall  and  the  lung  sticks 
out  or  escapes  through  it.  But  the  word  hernia  is  at  the 
present  day  almost  exclusively  used  to  mean  a  rupture  or 
tear  of  some  part  of  the  belly  watt,  which  allows  a  " knuckle" 
of  bowel  to  slip  through  it  and  appear  as  a  tumor  (or 
swelling)  beneath  the  skin.  The  rupture  does  not  affect 
the  skin  but  the  layers  of  muscles  and  membrane,  which  are 
less  tough. 

The  anatomy  and  contents  of  hernial  protrusions  are 
difficult  to  understand,  and  we  shall  not  attempt  a  popular 
description. 

The  important  thing  for  the  sufferer  and  for  the  general 
reader  is  to  understand  something  about  the  different  types 
of  rupture  and  the  risks  attending  the  neglect  of  a  rupture. 

Rupture  at  the  navel  (umbilical  hernia)  occurs  in  in- 
fants sometimes,  and  is  seen  as  a  lump  pushing  the  navel 
an  inch  or  two  out  of  the  belly,  especially  prominent  when 
the  child  strains  or  cries.  A  concave  circular  pad  and 
bandage  will  have  to  be  worn.  Some  doctors  make  a  pad 
out  of  a  cut  beer-bottle  cork  and  apply  it  with  adhesive 
plaster. 

Inguinal  hernia. — This  is  a  rupture  at  the  groin.  The 
swelling  may  be  either  very  slight,  or  considerable,  and  in 
men  the  lump  escapes  down  into  the  purse  or  scrotum,  and 
lies  alongside  of  the  testicle  there.  This  is  the  commonest 
form  of  rupture. 

Femoral  hernia  is  the  variety  which  is  most  common  in 
women.  There  is  a  lump  under  the  skin  at  the  upper  and 
inner  part  of  the  thigh. 

Double  hernia. — Any  person  may  have  a  rupture  on  both 
sides,  and  they  may  be  of  different  varieties. 


HERNIA  141 

Ventral  hernia  is  the  name  given  to  a  protrusion  of  the 
bowel  through  some  artificially-made  opening,  such  as  the 
weak  scar  of  an  old  abdominal  operation. 

Congenital  hernia  is  one  which  exists  at  birth. 

Acquired  hernia  is  one  which  is  developed  later  in  life 
through  a  strain  or  accident. 

Reducible  hernia  is  a  rupture  in  which  it  is  possible  at 
any  time  to  return  the  tumor  into  the  place  where  it  be- 
longs by  gentle  pressure  with  the  fingers  in  the  right  direc- 
tion. 

An  irreducible  hernia  is  one  which  cannot  be  returned  to 
where  it  belongs,  either  because  it  sticks  to  its  new  sur- 
roundings because  of  inflammation ;  or  because  it  has  grown 
too  fat  since  it  escaped  through  the  rupture,  or  for  some 
similar  reason. 

A  strangulated  hernia  is  one  in  which  a  large  knuckle  of 
bowel  has  been  forced  (by  coughing  or  straining)  through 
a  very  narrow  orifice,  and  the  tightness  of  the  opening  in- 
terferes with  the  proper  circulation  of  the  blood  in  the 
bowel.  By-and-bye  the  bowel  tumor  swells  up,  and  unless 
a  surgeon  can  succeed  in  " reducing  the  swelling"  or  in 
cutting  through  the  band  of  constriction,  the  bowel  will 
mortify,  and  the  patient  will  die  of  shock  and  blood  poison- 
ing. Any  hernia  may  become  strangulated. 

Causes. — Many  hernias  are  produced  suddenly  by  strain- 
ing. The  patient  feels  something  give  way  and  finds  a 
lump  there.  More  often  the  hernia  develops  gradually,  in 
a  person  who  is  always  lifting  heavy  weights  or  doing  work 
that  is  too  much  for  him.  In  coughing  or  straining  in  the 
w.c.  the  hernia  "comes  down,"  and  the  patient  feels  in- 
secure and  presses  his  hand  over  the  rupture.  Even  a  small 
rupture  is  apt  to  produce  constipation  (costive  bowels). 

Symptoms  of  strangulation. — If  in  a  person,  known  or 
not  known  to  have  a  rupture,  there  occurs  a  sudden  ab- 
dominal pain  at  the  seat  of  the  rupture,  stoppage  of  the 
bowels,  and  vomiting,  the  probability  is  that  he  has  a 
strangulated  hernia,  and  a  doctor  must  be  sent  for  at  once. 
Every  minute  of  delay  is  dangerous.  An  operation  will 
probably  have  to  be  done  in  any  case,  but  the  longer  the 
delay  the  more  severe  will  be  the  operation.  Old  persons 
who  may  have  had  ruptures  for  many  years  without  much 
trouble  from  them  may  be  taken  with  serious  sudden  vomit- 
ing, pain,  and  costiveness;  and  such  cases  ought  always  to 


142  HERNIA 

be  examined  to  see  if  they  have  a  strangulated  hernia  or 
not. 

Treatment. — There  are  two  ways  of  dealing  with  a  rup- 
ture. The  person  must  either  wear  a  truss  or  he  must  un- 
dergo an  operation  for  a  radical  cure  of  the  hernia,  and 
in  most  cases  the  operation  is  by  far  the  better  way. 

Of  trusses,  we  may  say  that  if  a  truss  fits  comfortably, 
keeps  back  the  hernia  entirely  and  produces  no  pain  nor 
chafing  of  the  skin,  it  may  be  considered  in  every  way  a 
suitable  instrument. 

"In  the  case  of  infants,  the  constant  application  of  a 
truss  day  and  night  will  effect  a  complete  cure  within  a 
year  in  the  majority  of  instances  of  inguinal  hernia," 
writes  Dr.  Whitla.  No  baby  is  too  young  for  a  truss,  but 
it  ought  to  be  made  waterproof  and  easily  cleanable.  The 
truss  may  be  left  off  six  months  after  the  rupture  is  con- 
sidered cured.  Adults  must  see  that  their  trusses  fit  accu- 
rately, which  cheap  trusses  seldom  do.  A  badly-fitting  truss 
causes  a  great  risk  of  strangulation.  Patients  must  have 
two  trusses  in  case  of  accidents,  while  one  is  undergoing  re- 
pairs. 

The  skin  under  the  truss  pad  should  be  kept  dusted  with 
zinc  oxide.  See  that  growing  young  people  with  ruptures 
are  kept  supplied  with  powder,  and  with  new  trusses  when 
they  grow  out  of  old  ones. 

In  young  people  with  recent  ruptures,  well-fitting  trusses, 
worn  night  and  day,  may  be  regarded  as  curative  in  many 
cases,  after  a  year  or  two. 

If  a  hernia  be  irreducible,  either  a  special  kind  of  truss 
must  be  worn,  or  the  hernia  must  be  cured  by  an  opera- 
tion. 

The  operation  for  the  radical  cure  of  herina  is  not  in  itself 
a  dangerous  one,  and  necessitates  lying  up  for  about  three 
weeks.  Only  an  operating  surgeon  can  decide  whether  the 
operation  ought  to  be  done  in  any  given  case.  Even  old 
people  with  old  ruptures  may  be  cured. 

The  operation  involves  no  risk  to  the  testicle  or  to  any 
other  organ. 

The  ailments  which  may  complicate,  or  be  mistaken  for 
hernia,  are: — Varicocele,  hydrocele  (a  collection  of  watery 
fluid  in  the  purse,  alongside  of  the  testicle)  ;  retained 
testicle  (that  is,  one  which  has  not  descended  from  the  ab- 
dominal cavity,  where  both  testicles  are  before  birth)  ; 


HEKPES  143 

hematocele  (an  effusion  of  blood  in  the  purse) ;  and 
others. 

Never  pay  heed  to  quacks  who  advertise  "cure"  of  rup- 
ture by  means  of  lotions  or  plasters. 

Herpes  (Pronounced  Her-peez). — "Shingles"  is  the  old- 
fashioned  popular  name  of  the  disease  which  medical  men 
called  Herpes  Zoster.  It  is  one  form  of  Herpes,  which  is 
a  skin  disease  marked  by  patches  of  inflamed  skin,  upon 
which  a  group  of  little  raised,  red,  tender  pimples  spring 
up.  These  pimples  grow  for  one  or  two  days,  and  then 
each  one  is  found  to  contain  a  little  drop  of  yellowish 
liquid;  at  length  they  burst,  or  else  the  heads  get  rubbed 
off,  and  a  little  sore  discharging  surface  remains  for  several 
days,  and  may  dry  up  into  one  or  more  little  scabs.  If  the 
scabs  are  not  disturbed  the  skin  heals  under  them,  and 
when  the  scabs  fall  off  there  is  only  a  little  reddened  patch, 
and  in  a  few  days  more  the  natural  appearance  is  re- 
stored, except  for  a  pale-brown  stain  which  lasts  a  few  days 
longer.  Shingles  appear  generally  on  the  ribs ;  it  may  effect 
one  side  only  of  the  chest,  or  both  at  once,  or  one  after  the 
other. 

Shingles  is  generally  accompanied  by  some  constitutional 
disturbance,  and  begins  with  a  chill  and  shivering.  Pain 
is  felt  in  the  side,  and  the  skin  is  tender,  before  any  spots 
appear;  this  pain  is  sometimes  quite  severe,  and  resembles 
neuralgia.  In  children  the  rash  is  found  to  give  rise  to 
intense  itching,  while  in  old  people  there  is  more  pain  and 
tenderness  than  irritation.  In  some  cases  the  pain  ceases 
when  the  rash  breaks  out,  and  is  replaced  by  a  sense  of 
constriction — a  tight  feeling,  with  smarting. 

The  eruption  often  comes  out,  not  all  at  once,  but  in  suc- 
cessive crops,  until  there  may  be  perhaps  a  dozen  little 
patches,  extending  half-way  round  the  chest.  These  run 
the  course  already  described. 

It  is  very  important  that  these  pimples  and  vesicles  should 
not  be  torn  by  scratching,  because  if  so  injured  there  may 
be  several  ulcers,  which  are  difficult  to  heal,  and  will  leave 
ugly  scars.  In  delicate  and  unhealthy  persons  the  glands 
in  the  armpit  may  become  a  little  tender  and  enlarged  for 
a  few  hours. 

This  is  a  somewhat  serious  disease,  especially  in  aged 
persons;  it  seems  to  be  generally  set  up  by  the  effect  of  a 
chill  to  the  skin.  The  disease  runs  a  course  of  a  fortnight, 


144  HIP-JOINT  DISEASES 

but  may  last  three  or  four  weeks.  In  the  beginning  of  the 
attack  it  is  well  to  go  to  bed  and  stay  there  for  a  week. 
Salines  and  purgatives  should  be  taken,  and  when  the  pain 
is  severe  opium  or  morphine  may  be  needed.  Locally,  zinc 
ointment  does  good,  or  the  rash  may  be  dusted  with  dry 
powder  of  starch  with  bismuth,  or  boric  acid,  and  a  little 
dry  morphine  may  be  needed. 

Mild  cases,  especially  those  which  are  relapses,  may  be 
treated  without  a  doctor,  but  if  the  pain  and  neuralgia 
which  accompany  and  follow  the  attack  are  bad  enough 
to  require  morphine,  a  doctor's  prescription  must  be  ob- 
tained, or  the  chemist  will  not  supply  the  medicine. 

The  special  treatment  of  Herpes  when  it  affects  the  lip 
(see  "Cold  in  the  Lip")  is  to  bathe  it  with  water,  as  hot  as 
can  be  borne,  in  which  some  bicarbonate  of  soda  has  been 
dissolved.  Bathe  it  several  times  a  day.  When  there  are 
scabs,  do  not  pick  them  off  but  apply  resin  ointment  at  bed- 
time. 

Hiccough  is  a  spasmodic  indrawing  of  the  breath,  which 
needs  no  special  description  as  it  is  familiar  to  everybody. 
Most  cases  of  it  are  caused  by  mere  indigestion ;  but  when 
it  occurs  in  such  serious  diseases  as  chronic  Bright 's  dis- 
ease and  typhoid  fever,  and  lasts  a  long  time,  it  is  a  sign 
of  grave  importance. 

Treatment. — Generally  none  is  needed.  A  teaspoonful 
of  compound  spirit  of  ether,  if  swallowed,  will  generally  stop 
the  hiccough.  When  continuous  and  excessive,  the  doctor 
ought  to  be  asked  to  treat  it. 

Hip-Joint  Diseases. — These  are  nearly  always  of  a  tuber- 
culous nature,  that  is,  are  caused  by  the  same  germ  which 
causes  "consumption  of  the  lungs."  The  disease  is  com- 
monest in  children  and  young  people.  At  the  very  first  the 
disease  of  the  joint  gives  no  pain  in  the  hip  joint  itself, 
but  the  child  will  complain  of  pain  in  the  knee  and  down 
the  inner  side  of  the  thigh.  Then  the  symptoms  of  the  hip 
mischief  begin. 

(1)  Slight  stiffness  at  the  hip  and  wasting  of  the  mus- 
cles and  flesh  of  the  thigh  on  that  side.     The  joint  soon 
gets  "tired." 

(2)  If  the  child  be  put  on  his  back  in  bed,  you  see 
that  he  bends  his  hip  a  little,  bends  his  knee  a  little,  and 


HOMEOPATHY  145 

turns  the  whole  leg  outwards,  separating  it  from  the 
other. 

(3)  When  the  child  walks  during  this  stage,  he  walks 
lame,  and  the  diseased  leg  appears  to  be  longer  than  the 
one  on  the  healthy  side. 

(4)  Later,  there  are  starting-pains  in  the  joint  at  night, 
and  if  you  put  the  child  on  its  back  in  bed  now,  or  watch 
it  standing  up,  you  will  see  that  the  leg  of  the  diseased 
side  is  turned  inwards,  nearer  to  the  other  and  with  that 
knee  over  the  sound  knee.     See  him  walk,  and  you  will 
notice  that  now  the  healthy  leg  seems  to  be  longer  than 
the  other  one. 

(5)  If  untreated  by  prolonged  rest  and  splints,  an 
abscess  will  form  in  the  diseased  joint  and  the  matter 
may  burst  through  the  skin  somewhere  or  go  into  the  back 
passage.     If  it  all  escapes  and  the  child  is  pretty  ro- 
bust the  joint  may  now  get  well,  but  it  will  remain  stiff 
and  fixed. 

It  is  useless  to  say  more  about  treatment  here.  These 
cases  cannot  be  dealt  with  except  by  a  surgeon. 

Homeopathy. — This  system  was  the  invention  of  a  Ger- 
man doctor,  named  Hahnemann.  It  is  based  on  the  theory 
that  ''like  cures  like";  for  instance,  vomiting  ought  to  be 
curable  by  an  emetic!  Keal  Homeopathy  has  proved  an 
utter  failure,  both  in  practice  and  in  theory,  and  the  mod- 
ern homeopathist  is  a  faddist,  and,  if  a  successful  healer, 
cannot  be  true  to  his  principles.  The  fundamental  rules 
of  homeopathy  are  these : — (1)  Ascertain  the  effects  of  medi- 
cine on  persons  in  health;  (2)  choose  the  remedy  whose  ac- 
tion corresponds  with  the  symptoms  of  the  patient;  (3)  give 
the  remedy  by  itself  alone;  (4)  give  a  very  small  dose  of 
it.  Hahnemann,  himself,  pretended  that  only  infinitesimal 
doses  were  necessary;  that  1-100,000  grain  of  belladonna, 
for  example,  is  enough  for  each  dose  in  the  treatment  of 
scarlet  fever.  But,  although  the  whole  theory  and  practice 
of  homeopathy  are  unworthy  of  serious  notice  to-day,  yet 
the  movement  has  had  its  uses  in  discouraging  the  over- 
use of  drugs,  and  in  encouraging  reliance  on  fresh  air, 
rest,  and  good  nursing.  Seeing  that  most  cases  of  illness 
tend  to  get  well  with  suitable  dieting,  rest,  and  fresh  air, 
there  can  be  no  doubt  that  the  addition  of  microscopic 


146  HYDROCELE 

doses  of  drugs  is,  in  the  way  of  treatment,  preferable  to 
the  continual  and  indiscriminate  tabloid-swallowing,  which 
is  so  common  at  the  present  day. 

Housemaid's  Knee. — Over  the  kneecap,  and  below  it,  we 
find  a  little  flattened  bag  of  liquid,  intended  by  Nature 
to  act  as  a  "buffer,"  and  protect  the  joint  from  injuries 
or  bruises,  such  as  might  be  produced  by  kneeling.  In  a 
housemaid,  who  kneels  often  for  long  periods,  while  scrub- 
bing and  polishing,  the  little  bag  (called  a  bursa)  at  the 
lower  edge  of  the  kneecap  is  apt  to  become  inflamed  and 
enlarged,  and  at  last  to  form  a  sort  of  tumor  below  the 
knee,  covered  with  a  tough  and  reddened  skin. 

Treatment. — Strong  iodine  liniment  should  be  painted  on 
all  over  the  bursa  daily  until  it  blisters.  Then  dress  the 
blister  with  clean  rag  or  lint,  smeared  with  boric  ointment, 
and  a  bandage.  If  this  plan  fails  the  doctor  will  "tap" 
the  swelling,  let  the  fluid  out,  and  inject  a  small  syringe- 
full  of  iodine  tincture  and  water  (equal  parts).  The  io- 
dine is  squeezed  out  again  after  a  few  minutes,  but  it  sets 
up  an  inflammation  in  the  little  bag,  which  results  in  its 
being  obliterated. 

Hydrocele. — This  is  a  collection  of  fluid  in  the  scrotum 
or  purse  of  the  male.  It  is  a  sort  of  dropsy  of  the  bag 
which  holds  the  testicles.  It  may  be  either  single  or  double 
— that  is,  on  one  side  only  or  on  both.  The  two  sides  of 
the  purse  are  quite  distinct  from  one  another,  and  each 
testicle  lies  in  a  pouch  of  its  own. 

Causes. — A  hydrocele  may  be  congenital — that  is,  a  child 
may  be  born  with  it — or  acquired.  Sometimes  it  seems 
to  come  from  a  bruise,  or  to  follow  inflammation  of  the 
testicles  (orchitis),  whether  due  to  an  injury  or  gonorrhea. 
But  very  often  the  cause  is  quite  unknown. 

Signs. — A  hydrocele  must  not  be  confounded  with  hernia 
or  varicocele,  or  enlargement  of  the  testicles,  or  hematocele 
(blood  tumor),  but  it  is  quite  impossible  to  teach  the  or- 
dinary reader  how  to  distinguish  between  these  various  dis- 
orders, because  he  probably  has  no  knowledge  of  anatomy. 
A  hydrocele  may  be  quite  small,  or  it  may  swell  to  the  size 
of  a  pumpkin.  It  is  not  painful,  or  tender,  or  red,  though 
it  may  feel  heavy.  It  is,  when  large,  a  pear-shaped  swell- 
ing with  the  pointed  end  towards  the  groin.  In  congenital 
hydrocele  the  bag  of  liquid  can  be  gradually  emptied 
through  the  neck  of  it  into  the  abdomen,  and  fills  up  again 


HYPOCHONDKIASIS  147 

when  the  patient  stands  up.  The  testicle  is  not  interfered 
with  and  can  be  felt  at  the  back  part  of  the  lower  end  of 
the  swelling. 

Treatment. — In  hydroceles  in  children  a  truss  must  be 
worn  to  encourage  the  closing  of  the  opening  between  the 
purse  and  the  belly.  Some  surgeons  then  irritate  the  skin 
over  it  with  iodine,  and  this  makes  the  fluid  absorb.  Others 
tap  the  little  tumor  and  withdraw  the  liquid.  After  that 
the  hydrocele  generally  gets  well  of  itself.  But  in  adults 
a  truss  is  of  no  use,  and  either  the  hydrocele  must  be  tapped 
regularly  as  soon  as  it  is  too  full  to  be  comfortable,  or  else 
an  operation  must  be  done  which  just  removes  the  ''wall" 
of  the  bag  of  fluid  and  then  there  can  be  no  more  dropsical 
swelling  for  there  is  no  place  for  it  to  collect  in.  Hydrocele 
is  not  dangerous,  nor  is  the  operation  for  it  a  dangerous 
one. 

Hypochondriasis  or  Neurasthenia. — This  long  scientific 
and  medical  word  is  the  name  of  a  complaint  which  is  very 
common  amongst  us,  though  you  may  never  have  heard  this 
long  word  before.  It  is  a  condition  of  the  mind  in  which 
the  sufferer  is  always  fancying  that  he  is  in  some  way  out 
of  health,  and  he  makes  himself  miserable  about  it. 

Most  hypochondriacs  are  in  the  possession  of  very  fair 
health  indeed ;  in  fact,  there  is  seldom  very  much  the  mat- 
ter with  them  except  a  disordered  fancy.  But  they  are  so 
selfishly  wrapped  up  in  their  fancied  ailments  that  they 
hardly  enjoy  life  at  all.  They  really  do  suffer,  from — 
nothing  in  particular !  But  their  sufferings  are  real  enough 
to  them,  and  we  should  pity  them  because  they  have  not 
the  strength  of  purpose  to  throw  off  their  morbid  fancies. 
There  are  plenty  of  hypochondriacs  among  middle-aged 
men,  especially  such  as  have  got  on  in  business,  and  have 
not  very  much  hard  work  to  do.  There  are  plenty  of  young 
men  also  in  the  same  category.  They  look  at  their  tongues 
in  the  glass  every  morning;  they  dose  themselves  con- 
tinually ;  they  read  the  long  accounts  in  the  advertisements 
of  patent  medicines,  and  they  believe  every  word  they  read. 
If  a  cold  bath  is  advised,  they  take  a  cold  bath;  if  a  cold 
bath  is  said  to  be  injurious,  they  cease  taking  a  cold  bath. 
They  study  all  their  insignificant  little  sensations,  and  read 
up  medical  books,  to  try  and  find  out  what  is  wrong  with 
them.  They  suffer  agonies  of  worry  and  trouble  because 
of  the  little  knowledge  which  is  to  them  so  dangerous  a 


148  HYSTERIA 

thing.  Some  of  them  fancy  they  have  this  complaint,  some 
that ;  and  every  little  sensation  makes  them  believe  they  are 
in  for  some  serious  disease.  They  buy  a  clinical  thermome- 
ter, and  tabloids,  and  tonics,  and  take  everything  and  any- 
thing— except  what  a  doctor  advises.  They  never  stick  to 
one  doctor ;  they  go  from  place  to  place  looking  for  a  doctor 
or  a  patent  medicine  advertisement  which  will  understand 
their  terribly  complicated  case!  There  are  many  women 
in  the  same  condition,  especially  those  who  have  no  work 
to  do  and  plenty  of  time  to  do  nothing  in.  Some  few  of- 
them  are  curable.  They  want  plenty  of  beef  steak,  bitter 
beer,  and  wholesome  stale  bread  and  cheese;  they  should 
avoid  pickles  and  indigestibles,  and  they  should  take  long 
walks  or  get  a  muscle  developer  and  use  it.  But  their 
minds  really  require  more  treatment  than  their  bodies,  and 
they  should  work  hard  at  anything  which  will  give  them  no 
time  to  think  of  Number  One!  Carlyle's  advice  to  all 
such  people  is  excellent: — "If  you  are  not  miserable,  be 
happy" — there  ought  to  be  no  half-way  conditions. 

Hysteria. — This  is  a  large  subject,  and  it  is  impossible 
for  us  to  do  more  than  give  an  outline  of  it.  By  Hys- 
teria we  mean  a  curable  nervous  disorder  which  leads  to 
various  disturbances  in  health,  such  as  numbness,  pain, 
paralysis,  flushings,  palpitations,  and  others  too  numerous 
to  mention.  A  person  who  is  subject  to  these  more  or  less 
avoidable  and  self-caused  symptoms  is  said  to  be  hysterical 
and  to  have  hysteria;  every  attack  of  such  symptoms  is 
called  an  hysterical  attack  or  fit  of  hysterics.  Clearly  un- 
derstand that  hysteria  is  real  disorder  of  the  controlling 
centers  of  the  brain;  it  is  not  shamming,  though  an  hys- 
terical girl  generally  shams  as  well. 

Most  hysterical  people  are  girls  in  their  teens,  but  some 
women  are  hysterical  all  their  lives.  Boys  occasionally  have 
hysterical  attacks,  and  even  men  are  sometimes  subject  to 
them.  The  tendency  to  hysteria  is  increased  by  bad  or 
weak  moral  training,  especially  by  mothers  who  "  cosset " 
their  children  and  lead  them  to  expect  undue  sympathy  in 
every  little  trouble.  The  hysterical  patient  has  no  "back- 
bone," no  "grit,"  as  we  say:  she  is  "namby-pamby"  and 
silly.  We  have  to  consider,  then,  what  are  the  signs  of 
hysteria  and  what  are  the  characters  of  an  hysterical  fit. 

Hysteria. — The  girl  or  woman  with  hysteria  is  emotional 
and  perhaps  very  sentimental.  She  laughs  or  cries  without 


HYSTERIA  149 

sufficient  reason.  She  wants  to  be  taken  notice  of  all  the 
time.  Without  sympathy  she  is  miserable,  and  the  result 
is  that  she  will  (in  bad  cases)  do  or  say  anything  which 
will  procure  sympathy  and  fussing.  She  may  even  produce 
illness  in  herself,  swallow  stones  or  needles,  or  make  erup- 
tions on  her  skin  with  acids  or  poisons  in  order  to  deceive 
her  doctor,  and  excite  his  and  others'  interest  and  sym- 
pathy. In  worse  cases,  she  begins  to  fancy  that  she  cannot 
move  an  arm  or  a  leg,  and  at  last,  having  made  herself  be- 
lieve that  she  can 't  move  it,  she  finds  that  she  is  really  para- 
lyzed. Or  she  may  become  voiceless,  or  rigid,  or  go  to 
sleep  for  weeks,  or  go  without  food  for  weeks,  with  or  with- 
out a  religious  motive.  Sometimes  the  senses  of  an  hys- 
terical woman  get  so  acute  and  sensitive  that  she  cannot 
bear  the  light  of  day  and  complains  of  the  least  touch  or 
noise.  Her  spine  is  very  likely  tender,  and  she  has  tender 
spots  in  various  places — especially  (1)  at  the  top  of  the 
head,  (2)  below  the  breasts,  and  (3)  on  each  side  of  the 
abdomen. 

Sometimes  the  symptoms  vary  from  day  to  day,  for  the 
hysterical  woman  will  soon  find  a  new  complaint  if  sym- 
pathy seems  to  be  on  the  wane.  She  cannot  bear  to  be 
forgotten  and  she  loves  to  be  pitied,  though  she  will  often 
say  that  she  wants  no  sympathy ! 

The  causes  of  hysteria  are  many;  among  them  are: — 
bad  moral  and  emotional  training  of  the  young,  mastur- 
bation, sexual  excesses,  impure  literature,  lack  of  physical 
exercise  and  fresh  air,  ancemia,  disappointment  in  love,  loss 
of  social  position,  emotional  shocks,  grief,  and  so  on. 

An  hysterical  fit  is  something  like  this: — the  girl  or 
woman  begins  by  laughing  or  crying,  or  doing  both  at  once, 
and  complains  of  a  feeling  as  if  a  ball  were  rising  into 
the  throat  and  making  a  choking  sensation.  Then  she  falls 
down  * '  in  a  fit, ' '  and  seems  to  be  quite  unconscious,  but  may 
recover  quite  suddenly,  especially  if  no  notice  whatever  is 
taken  of  her,  or  if  someone  says  aloud  that  he  is  going  to 
drench  her  with  cold  water.  But  the  forms  of  hysterical 
fits  are  very  numerous,  and  we  cannot  say  more  about 
them  here. 

Treatment. — Slight  cases  of  hysteria  can  be  treated  at 
home,  hysterical  girls  who  fast,  sleep  for  days  or  weeks,  are 
paralyzed,  erotic,  or  subject  to  trances,  must  be  treated  in 
a  suitable  institution.  The  home  treatment  of  hysteria  is 


150  IDIOSYNCRASY, 

not  difficult  if  the  parents  and  friends  are  sensible  and  not 
sentimentally  foolish.  The  girl  needs  plenty  of  rest,  good 
food,  moderate  exercise,  laxatives  for  the  bowels,  iron  tonics 
for  the  blood — but  no  fussing  or  sympathy.  Special  symp- 
toms, such  as  pain,  need  medical  advice. 

As  to  the  fits — in  slight  attacks  no  treatment  is  needed. 
The  girl  or  woman  must  be  encouraged  at  other  times  to 
exert  self-control,  but  when  the  fit  comes  leave  her  in  a  room 
quite  alone.  Or  watch  her,  if  you  are  anxious,  but  only  if 
you  can  do  it  without  her  knowledge.  She  is  very  sharp, 
and  if  she  finds  out  you  are  watching,  her  fit  will  get  worse 
and  worse.  Yet  she  is  not  shamming,  she  is  suffering  from 
a  mental  disorder.  The  mere  mention  of  a  jug  of  cold 
water  will  generally  cure  her,  because  dislike  of  a  cold 
douche  or  the  application  of  strong  smelling  salts  to  her 
nose  forces  her  to  exert  self-control.  But  if  the  name 
"cold  water"  does  not  cure  her,  pour  it  over  her,  or  dash 
the  water  in  her  face  without  hesitation.  The  essential 
thing,  between  the  fits,  is  to  make  her  understand  that  you 
are  sorry  for  her,  but  that  she  shall  have  no  sympathy  un- 
less she  tries  to  control  herself. 

Idiosyncrasy. — This  word  implies  nothing  more  than 
"personal  peculiarity,"  and  is  used  by  doctors  with  refer- 
ence chiefly  to  the  effect  of  medicines.  Some  people  can- 
not, for  example,  take  even  five  grains  of  iodide  of  potas- 
sium without  getting  watery  eyes  and  all  the  signs  of  a  cold 
in  the  head!  Others  can  take  twenty  grains  of  the  same 
drug,  three  times  a  day,  with  benefit.  The  same  pecul- 
iarities apply,  of  course,  in  the  case  of  alcohol,  arsenic, 
shellfish,  eggs,  porridge;  some  people  like  these  things  and 
some  cannot  take  them  without  feeling  ill.  Many  people 
get  singing  in  the  ears  and  giddiness  from  even  small  doses 
of  quinine ;  others  take  quinine  to  cure  noises  in  their  ears ! 
' '  One  man 's  meat  may  be  another  man 's  poison, ' '  says  the 
old  proverb,  and  it  is  a  very  true  one.  This  makes  it  diffi- 
cult to  find  a  good  definition  for  poison.  Powdered  glass  if 
swallowed,  will  probably  cause  death,  and  so  might  boil- 
ing water,  but  one  cannot  call  these  things  poison.  One 
man  can  take  a  quarter  of  a  grain  of  morphine  with  noth- 
ing but  a  feeling  of  drowsiness,  whereas  the  same  dose 
would  be  fatal  to  many  women  and  most  children. 

The  moral  to  be  drawn  from  all  this  is  to  avoid  buying 
and  swallowing  tabloid  medicines  without  a  doctor's  pre- 


INDIGESTION  151 

scrip tion  and  advice,  just  because  someone  (non-medical, 
like  yourself)  has  said  that  they  are  "good  for"  your  com- 
plaint. In  health,  certain  medicines  (like  morphine, 
atrophine  and  aconite)  are  actually  poisonous;  in  some 
forms  of  disease,  and  with  some  idiosyncrasies,  they  are 
beneficial,  and  may  even  save  life ! 

Imperial  Drink. — For  persons  with  feverishness  or  any 
acute  feverish  disease,  and  for  those  with  Bright 's  disease, 
who  suffer  much  from  thirst.  Pour  a  pint  of  boiling  water 
on  a  large  teaspoonful  of  cream  of  tartar,  a  little  sugar, 
and  a  few  bits  of  lemon  peel.  Strain  when  quite  cold  and 
serve. 

Impotence. — Let  no  one  hesitate  to  consult  a  doctor.  A 
young  man  may  imagine  that  other  young  men  are  not 
troubled  with  these  matters,  but  really  they  are  very  com- 
mon, and  the  doctor  has  heard  the  whole  story  before,  many 
a  time,  and  is  quite  well  able  to  tell  you  how  to  deal  with  it. 

Indigestion. — So  very  many  persons  are  always  suffering 
from  chronic  indigestion,  that  we  feel  obliged  to  refer  to 
this  subject  at  length.  Some  have  dyspepsia,  or  indiges- 
tion, because  the  digestive  organs — the  stomach,  bowels,  or 
liver — are  diseased ;  others  suffer  because  they  eat  either  too 
much,  or  eat  unwholesome  food;  while  a  third  group  of 
patients  suffer  indigestion  because  they  drink  to  excess. 
Habits  of  chronic  intemperance  are  sure  to  ruin  the  coats 
of  the  stomach,  and  to  harden  the  liver,  sooner  or  later,  and 
very  often  injure  the  kidneys  as  well.  In  the  early  days 
of  free  drinking  a  change  to  total  abstinence  is  often  quickly 
followed  by  a  complete  recovery;  but  when  alcoholism  has 
destroyed  the  liver  cells  there  can  be  no  recovery  of  good 
digestion.  Apart,  however,  from  alcoholic  drink,  the  con- 
sumption of  too  large  a  quantity  of  food,  and  especially 
the  habit  of  taking  meals  too  close  together,  may  render 
a  state  of  healthy  digestion  impossible.  The  stomach  needs 
rest  as  much  as  the  mind,  or  the  body  in  general ;  it  ought 
to  empty  itself  into  the  intestines,  and  remain  empty  for 
one  or  two  hours  between  each  meal.  Almost  all  of  us  eat 
too  much;  that  is,  we  eat  more  than  is  needed  to  supply 
energy  and  to  keep  up  the  body  weight.  Persons  in  poverty 
who  cannot  get  enough  to  eat  rarely  suffer  from  indigestion. 
Most  people  are  all  the  better  for  an  occasional  day  of  fast- 
ing, say,  once  every  month.  The  Roman  Catholic  Church 
was  wise  in  making  all  Catholics  fast  on  one  day  every 


152  WATERBRASH 

week,  and  also  live  sparingly  for  forty  days  every  year  in 
Lent,  which,  happens  in  the  springtime.  When  indigestion 
is  the  result  of  organic  disease  of  the  stomach  or  liver,  or 
when  it  is  an  accompaniment  of  consumption,  there  will  be 
great  difficulty  in  curing  it.  Medicines  may  have  to  be 
taken  for  months  together,  and  seem  to  have  very  little 
effect  in  giving  relief.  The  usual  symptoms  are  deficient 
appetite,  unpleasant  taste  in  the  mouth,  oppression  felt  in 
the  chest  after  food,  and  this  may  last  for  hours  (see  also 
"Acidity")  ;  pains  in  the  chest,  flatulence,  and  belching 
upward  of  wind  or  gases.  Some  persons  also  have  water- 
brash  and  heartburn,  also  occasional  nausea  and  vomiting; 
the  action  of  the  bowels  may  be  either  relaxed  or  too  con- 
stipated, and  there  may  be  piles.  The  treatment  of  indi- 
gestion must  vary  with  the  peculiarities  of  the  patient  and 
with  its  cause.  (See  also  "Salisbury  Treatment.") 

Very  few  people  will  take  the  trouble  carefully  to  study 
even  a  popular  work  on  Indigestion,  and  so  they  go  on 
suffering  for  years,  and  only  learning  by  bitter  experience 
how  to  avoid  the  chief  troubles  of  dyspepsia  by  avoiding 
the  foods  (sometimes)  that  they  most  enjoy!  We  have  de- 
cided that  our  best  plan  is  not  to  describe  the  types  of 
indigestion  but  to  resort  to  the  method  of  giving  a  list  of 
the  principal  symptoms  and  hints  as  to  how  to  deal  with 
them.  Of  one  thing  be  certain — the  cure  must  be  by  means 
of  proper  diet,  not  by  drugs. 

Heartburn  (see  article  on  "Acidity"). 

Flatulence  (Wind  in  the  Stomach,  Belching,  Fullness 
after  Food). — It  is  a  mistake  to  belch,  or  to  try  and  "raise" 
the  wind;  more  air  is  swallowed  and  the  distress  only  in- 
creases. A  little  dried  Poplar  Charcoal  (say  5  grains,  with 
5  grains  of  bismuth  subnitrate)  swallowed  in  a  cachet  just 
before  each  meal  is  very  useful.  A  few  drops  of  essence 
of  ginger,  of  peppermint,  of  cloves,  or  of  cajuput  at  meal- 
times are  often  serviceable.  Pepsin  and  papain  in  large 
doses  are  also  good  for  flatulence.  Soups,  eggs,  starches, 
fruits,  vegetables,  should  be  eaten  sparingly.  A  dry  meat 
diet  is  often  best. 

Waterbrash. — This  is  a  gush  of  acid  fluid  (chiefly  saliva) 
which  comes  into  the  mouth  after  an  attack  of  pain  in  the 
stomach. 

Try  the  following  mixture: — Sodium  bicarbonate,  15 
grains;  magnesium  carbonate,  10  grains;  compound  carda- 


INFANT  FEEDING 


153 


moms  tincture,  1  drachm;  aromatic  spirit  of  ammonia,  ^ 
drachm;  caraway  water  to  one  ounce.  The  draught  to  be 
taken  occasionally. 

Flushing  after  meals. — Take  a  one-grain  pill  of  creosote 
made  with  soap,  after  food,  thrice  daily.  Or,  a  half  minim 
creosote  pill. 

Vomiting. — The  cachets  of  bismuth  and  charcoal  above 
mentioned  are  useful. 

Foul  breath. — Sodium  bicarbonate,  10  grains;  carbonate 
of  bismuth,  5  grains;  tincture  of  chiretta,  10  minims;  in- 
fusion of  quassia,  %  ounce.  Take  this  draught  half  an 
hour  before  each  meal,  and  look  well  to  the  state  of  mouth 
and  teeth. 

Infant  Feeding. — No  other  one  factor  in  the  health  of  an 
infant  compares  for  a  moment  in  importance  with  the  man- 
ner in  which  it  is  fed.  Breast  feeding  may  be  more  diffi- 
cult to  carry  out  than  bottle  feeding ;  but  according  to  Holt 
the  mortality  of  bottle-fed  infants  during  the  first  year  is 
fully  three  times  as  great  as  that  of  those  who  are  breast 
fed. 

Dr.  Winter  says  that  while  very  few  breast-fed  infants 
die,  the  mortality  of  bottle-fed  infants  in  tenements  and 
institutions  may  be  as  great  as  59  to  93  per  cent. 

These  figures  apply  to  those  cases  where  our  modern 
knowledge  of  artificial  infant  feeding  is  not  applied.  With 
care  these  percentages  can  be  much  reduced ;  but  no  matter 
how  perfect  our  methods  of  artificial  feeding  are  they  can 
never  equal,  in  their  results,  the  effects  of  breast  feeding. 

Breast  Feeding. — During  the  first  day  the  infant  need 
have  nothing  but  water. 

Little  milk  is  secreted  by  the  mother  until  the  third  day. 
The  number  of  daily  nursings  and  the  intervals  are  shown 
by  the  following  table  (from  Holt). 


Period 

Nursings  in 
24  hours 

Interval  by  day 
hours 

Night  nursing 

(10  P.M.  to  6  A.M.) 

1st  &  2nd  day 

4 

6 

1 

3  days  to  6  weeks  .  .  . 
6  weeks  to  3  months  . 
3  to  5  months  
5  to  12  months  .... 

10 

8 
7 
6 

2 

2y2 

3 
3 

2 
2 
1 
0 

154 


ARTIFICIAL  FEEDING 


The  mother  should  have  a  simple  but  generous  diet  with 
plenty  of  fluids.  Eggs,  cereals,  soups,  vegetables,  meat 
once  a  day,  gruel,  milk,  or  cocoa  at  bedtime. 

She  should  avoid  worry,  anxiety,  fatigue,  social  dissipa- 
tion, grief,  excitement,  fright  and  passion. 

There  is  no  objection,  after  the  first  few  months,  to  sub- 
stituting bottle  feeding  for  some  of  the  breast  feedings. 
Weaning  should  be  begun  gradually  at  nine  or  ten  months 
and  completed  at  one  year. 

Artificial  Feeding. — Milk  for  artificial  feeding  should 
come  from  healthy  cows  and  be  clean  and  fresh. 

It  is  preferable  if  it  is  "certified,"  pasteurized,  or  both. 

In  making  up  the  following  formulas  (according  to  Holt) 
7  per  cent,  milk  is  used.  This  is  obtained  by  removing 
the  upper  half  from  a  quart  bottle  of  milk  which  has  stood 
at  least  four  hours.  It  can  also  be  obtained  by  mixing 
three  parts  of  milk  and  one  part  of  ordinary  (16  per  cent.) 
cream. 

Nine  formulas  are  employed  for  different  periods  of  the 
child's  development. 

They  are  made  as  follows : — 


1 

II 

III 

IV 

V 

VI 

VII 

VIII 

IX 

oz. 

oz. 

oz. 

oz. 

oz. 

oz. 

oz. 

oz. 

oz. 

7-per  cent,  milk 

2 

3 

4 

5 

6 

7 

8 

9 

10 

Milk  sugar  .... 

1 

1 

1 

1 

1 

1 

1 

1 

1 

Lime  water  .... 

1 

1 

1 

1 

1 

1 

1 

1 

1 

Boiled  water    .  . 

17 

16 

15 

14 

13 

12 

11 

10 

9 

Totals    

20 

20 

20 

20 

20 

20 

20 

20 

20 

Formula  I  is  begun  on  the  second  day;  II  on  the  fourth 
day;  III  at  ten  to  fourteen  days;  but  after  that  the  in- 
crease is  made  more  slowly.  A  healthy  infant  with  good 
digestion  will  be  able  to  take  formula  V  by  the  time  it  is 
three  or  four  weeks  old. 

Formulas  from  7  per  cent,  milk  can  be  continued  until 
the  child  is  six  or  seven  months  old.  Then  a  change  should 
gradually  be  made — using  whole  milk.  Instead  of  remov- 
ing the  upper  16  ounces,  one  may  for  two  weeks  remove  the 
upper  18  ounces. 

For  the  next  two  weeks  remove  the  upper  20  ounces  and 
for  the  next  two  weeks  remove  the  upper  24  ounces. 


FEEDING 


155 


After  this  the  bottle  may  be  shaken  up  and  the  whole 
milk  used  (Holt). 

For  artificial  feeding  of  infants  during  the  first  year  the 
following  table  will  be  of  service. 


Age 

Interval 

between 
meals  by 

Night 
feedings 
10  p.  m. 

No.  of 
feed- 
ings 
in  24 

Quantity 
for 
one  feeding 

Quantity 
for 
24  hours 

day 

to  7  a.  m. 

hours 

Hours 

Ounces 

Ounces 

2nd  to  7th  day     ... 

2 

2 

10 

l-ll/2 

10-15 

2nd  &  3rd  weeks    .  . 

2 

2 

10 

li/8-3 

15-30 

4th  &  5th  weeks    .  . 

2 

1 

10 

2y2-3i/2 

25-35 

6th  to  9th  weeks    .  . 

2ya 

1 

8 

3-5 

24-40 

9th  week  to  5th  mo.  . 

3 

1 

1 

4-6 

28-42 

5th  to  9th  month     . 

3 

0 

6 

5-7y2 

30-45 

9th  to  12th  month  . 

4 

0 

5 

7-9 

35-45 

The  entire  amount  for  the  24  hours  should  be  made  up  at 
one  time,  placed  in  bottles  containing  the  exact  amount  for 
a  single  feeding  and  pasteurized. 

At  the  end  of  six  months  a  little  farinaceous  food  may 
be  added  to  the  diet — also  a  little  beef  juice,  the  white  of 
an  egg  and  orange  juice. 

For  vomiting  the  amount  of  milk  must  be  reduced,  or 
the  fat  content  of  milk  should  be  reduced  and  the  lime 
water  increased. 

For  colic  or  constipation  strengthen  the  formula,  sub- 
stitute milk  of  magnesia  for  lime  water  or  replace  milk 
sugar  by  maltose. 

For  diarrhea  diminish  the  fat  content  of  the  milk,  boil 
it  and  dilute  it  if  undigested  milk  appears  in  the  stools. 

The  best  forms  of  pasteurizers  are  the  Freeman  and  the 
Walker-Gordon. 

As  soon  as  the  bottles  are  emptied  they  should  be  rinsed 
with  cold  water  and  allowed  to  stand  filled  with  water  to 
which  a  little  bicarbonate  of  soda  has  been  added.  Before 
the  milk  is  put  into  them  they  should  be  thoroughly  washed 
with  a  bottle  brush  and  hot  soap-suds  and  then  placed  for 
twenty  minutes  in  boiling  water. 

Feeding  during  the  Second  Year : — 

Five  feedings  a  day  should  be  given  with  milk  at  10 
p.  M.  if  the  child  is  awake,  from  the  bottle. 

The  following  are  given  until  the  fourteenth  month — 


156  INFANTILE  PARALYSIS 

milk  with  gruel,  orange  juice,  beef  juice,  white  of  egg  and 
mutton  or  chicken  broth. 

From  the  fourteenth  to  the  eighteenth  month  the  follow- 
ing are  given: — milk  (warmed),  fruit  juice,  oatmeal  or 
hominy  with  cream,  dry  toast,  beef  juice,  egg,  rice,  broth 
and  scraped  beef. 

After  this,  until  the  end  of  the  second  year,  may  be 
added  beefsteak,  mutton  chop  or  roast  beef,  prune  pulp  or 
baked  apple. 

Feeding  during  the  Third  Year : — 

The  night  feeding  at  10  p.  M.  should  be  omitted.  The 
midday  meal  should  be  increased.  Three  regular  meals 
should  be  given  and  milk  once  besides. 

To  the  second-year  diet  may  be  added  baked  white  po- 
tato, boiled  rice  or  spaghetti,  asparagus  tips,  string  beans, 
peas  and  spinach — all  cooked  until  soft  and  mashed. 

Condensed  milk  and  proprietary  foods. — If  these  foods 
are  used  to  correct  symptoms  of  indigestion  they  should 
be  used  for  a  few  weeks  only. 

Most  of  them  are  low  in  fat  and  proteids  and  high  in 
sugar. 

Children  fed  upon  them  for  too  long  a  time  are  liable  to 
develop  rickets  and  sometimes  scurvy. 

Infantile  Paralysis  (Acute  Anterior  Poliomyelitis).— 
This  is  an  acute  disease  characterized  by  the  rapid  onset 
of  paralysis  with  fever.  While  it  is  usually  confined  to 
infants  and  children,  adults  may  also  contract  it.  It  is 
most  prevalent  in  summer  and  has  recently  been  occurring 
in  epidemic  form.  The  paralysis  is  most  common  in  one 
or  both  legs,  but  the  arms  may  be  affected.  After  a  mild 
attack  the  paralysis  may  disappear  entirely.  In  all  cases 
some  of  the  paralysis  disappears,  but  as  a  rule  the  paralysis 
which  remains  is  sufficient  to  cause  considerable  deformity 
and  disability.  In  addition  to  the  paralysis  and  fever, 
there  may  be  pain  and  tenderness,  headache,  restlessness 
and  muscular  twitching.  Few  cases  die. 

Infantile  paralysis  is  a  disease  due  to  a  germ  so  small 
that  it  has  never  been  seen,  which  attacks  the  spinal  cord 
and  produces  local  injury  there. 

Early  treatment  consists  of  rest  in  bed,  counter-irritation 
over  the  spine  and  local  antisepsis  of  the  mucous  membranes 
of  the  mouth  and  nose.  Later  the  services  of  an  expert 
physician  are  most  necessary  to  prevent  deformity  by  means 


INFLUENZA  157 

of  electricity,  massage  and  the  use  of  mechanical  appli- 
ances. 

Since  1907  when  the  first  large  epidemic  occurred  in  this 
country  in  and  near  New  York  City  the  disease  has  been 
spreading  rapidly  until  during  the  past  year  there  have 
been  epidemics  in  31  states. 

Prevention. — As  the  disease  is  communicable  and  to  some 
extent  contagious,  all  cases  should  be  isolated  for  at  least 
a  month — as  the  disease  germ  has  been  found  in  the  secre- 
tions from  several  weeks  to  several  months. 

While  the  exact  modes  of  transmission  are  not  yet  known 
there  is  a  suspicion  that  it  may  be  caused  by  flies,  fleas  or 
street  dust.  It  may  be  carried  by  a  person  who  has  been 
exposed  even  if  not  a  sufferer.  As  the  most  common  point 
of  entry  of  the  germ  into  the  body  is  the  mucous  membrane 
of  the  nose,  not  only  should  all  nasal  and  oral  discharges  of 
the  sufferers  be  disinfected  and  destroyed,  but  those  ex- 
posed (and  we  are  all  constantly  exposed)  should  cleanse 
their  nasal  cavities  and  mouths  several  times  daily  with 
some  mild  antiseptic  solution  such  as  Liquor  Antisepticus 
Alkalinus. 

While  monkeys  have  been  immunized,  it  has  not  yet  be- 
come practicable  to  immunize  human  beings.  One  attack 
protects  from  subsequent  ones. 

Inflammation. —  (See  "Abscess.") 

Influenza  is  an  epidemic  fever,  accompanied  always  by 
catarrh  of  some  part  of  the  body  or  other.  It  begins  about 
a  week  after  infection,  and  it  begins  suddenly,  with  a  rapid 
rise  of  temperature,  which  it  needs  no  clinical  thermom- 
eter to  prove.  The  feverishness  lasts  nearly  a  week  in 
ordinary  cases,  and  ends  suddenly  in  an  attack  of  perspira- 
tion. There  are  at  least  four  quite  different  types  of  in- 
fluenza, and  the  same  poison,  whatever  it  may  be,  seems 
to  cause  them  all.  Everybody  who  catches  influenza  has 
three  symptoms — feverishness;  "cold"  in  the  head,  nose, 
eyes,  throat  or  chest;  and  extreme  prostration.  But  some 
people  have  other  things  added  to  these :  for  example,  bron- 
chitis and  pneumonia;  or  palpitations,  flushing,  fainting, 
sweating  and  gasping;  or  diarrhea,  vomiting,  jaundice;  or 
skin  eruptions;  or  mental  troubles.  Everything  depends 
upon  which  part  of  the  body  is  attacked.  There  is  very 
seldom  a  rash,  but  there  may  be  a  rose-rash  which  soon 
fades.  Nearly  every  case  of  influenza  which  is  going  to 


158  INSANITY 

be  serious  is  accompanied  by  dreadful  pains  in  the  head, 
back  and  limbs. 

Influenza  is  infectious  and  epidemic,  and  it  is  due  to 
a  germ,  which  is  coughed  into  the  air  and  is  inhaled  by 
sufferers.  You  may  have  numerous  attacks;  one  attack 
does  not  protect  you  from  a  second.  Old  and  young,  poor 
and  rich,  all  stand  a  good  chance  of  being  attacked  during 
an  epidemic. 

The  first  thing  to  do  when  you  are  seized  with  influenza 
is  to  send  for  the  doctor.  He  will  know  how  to  nip  the 
mischief  in  the  bud,  if  it  ever  can  be  thus  nipped,  and  the 
earlier  treatment  is  begun  the  better  chance  you  will  have 
of  escaping  lightly.  Only  about  one  person  in  a  hundred 
cases  dies  of  influenza,  but  many,  very  many,  are  left  pros- 
trate for  weeks,  if  not  months,  afterwards,  and  many  are 
never  the  same  again  after  an  attack.  So  do  not  waste 
precious  hours  in  self-doctoring,  or  you  may  regret  it  all 
your  life.  In  middle-aged  and  elderly  folks  the  attack  is 
only  too  likely  to  be  complicated  by  pneumonia  (inflamma- 
tion of  the  lungs).  In  younger  people,  an  attack  of  in- 
fluenza is  often  trivial  and  recovery  occurs  in  a  few  days. 
But  it  will  not  do  to  presume  too  much  on  one's  former 
health  and  strength ;  and  relapses  are  quite  common. 

You  must  keep  the  patient  in  bed  during  the  attack ;  and 
until  the  doctor  comes  you  may  give  a  teaspoonful  of  am- 
moniated  tincture  of  quinine  every  two  hours,  and  some 
strong  beef  tea  and  good  cognac  brandy  in  it.  Do  not  let 
him  take  antipyrin  or  any  such  strong  medicine  without 
medical  advice,  lest  you  damage  his  heart,  which  will  re- 
quire all  the  power  it  possesses  if  complications  should  arise. 
Afterwards,  a  tonic  will  be  required.  If  possible  a  change 
of  air  and  a  thorough  rest  should  be  undertaken. 

Insanity. — Not  very  many  years  ago  a  madman  or  mad- 
woman got  very  little  sympathy,  and  was  locked  up  in  an 
insanitary  madhouse,  looked  after  by  ignorant  and  often 
brutal  attendants,  and  hastened  to  death,  or  worse  forms  of 
madness,  by  neglect,  cruelty,  starvation,  or  accident.  If 
the  mad  person  were  raving,  noisy,  and  destructive,  he  was 
tied  down,  confined  in  a  dark  room,  or  half -smothered  with 
clothes.  If  he  believed  himself  persecuted  by  poisoners, 
he  would  refuse  all  food,  and  then  would  probably  be  left 
to  starve.  If  he  were  depressed  and  melancholic,  he  would 
be  left  alone,  and  shunned  and  neglected.  If  he  were  in- 


INSANITY  159 

clined  to  commit  suicide  very  little  trouble  was  taken  to 
prevent  his  doing  so,  and  sooner  or  later  he  generally  suc- 
ceeded. If  he  were  homicidal,  he  would  be  chained  up, 
and,  if  he  were  a  person  of  no  importance,  would  probably 
be  utterly  neglected,  and  die  of  some  disease  caused  by 
unhealthy  surroundings.  A  great  many  cunning  lunatics 
were  able  to  conceal  their  disorder,  and  keep  out  of  asylum, 
because  of  the  ignorance  of  doctors,  as  well  as  of  the  public, 
on  the  subject  of  mental  disease. 

In  this  way  anyone  who  became  so  insane  as  to  require  to 
be  locked  up,  became  at  once  a  disgrace  to  the  family — a 
skeleton  in  the  cupboard  whose  existence  was  concealed  at 
any  cost,  and  a  stigma  on  all  the  relations.  If  a  man  had 
cancer,  or  was  a  drunkard,  he  was  pitied  or  despised;  but 
if  his  mind  gave  way,  he  was  shunned,  and  ran  the  risk  of 
dying  of  neglect.  He  was  thought  by  the  ignorant  pious 
to  be  possessed  of  a  devil,  or  to  be  a  wizard  or  a  witch.  A 
madman  rarely  recovered,  for  his  unmerited  sufferings  in- 
creased his  madness,  and  to  the  tortures  of  mental  pain 
were  added  the  unkindness  (often  ignorant  rather  than  in- 
tentional) of  those  sane  and  well. 

At  the  present  day  the  lot  of  the  insane  is  very  greatly 
improved,  and  mental  disease  is  a  department  of  the  study 
of  medicine  in  which  very  great  progress  is  being  made. 
It  is  probably  true  that  at  no  period  of  the  world's  history 
have  the  needs  of  the  mad  been  so  well  understood  and 
catered  for  as  at  the  present  day.  Of  late  years  the  study 
of  madness  has  been  recognized  as  the  province  of  the 
physician,  and  not  of  the  lawyer,  or  clergyman,  or  mad- 
house keeper.  There  are  a  great  many  things  connected 
with  lunacy  which  are  still  in  the  hands  of  lawyers,  and 
plenty  of  instances  where  the  attitude  of  the  Law  towards 
criminals  who  are  mad,  rather  than  bad,  or  who  are  both 
mad  and  bad,  is  manifestly  unjust  and  wrong.  Still,  things 
are  improving,  and  it  is  the  medical  expert  who  generally 
decides  as  to  the  alleged  insanity  of  a  criminal,  though  it 
is  the  judge  still  who  apportions  the  responsibility. 

Just  as  in  all  other  branches  of  the  art  of  medicine,  so  in 
the  science  of  mental  disease — people  who  are  quite  igno- 
rant of  the  subject  are  apt  to  express  opinions  about  pa- 
tients who  are  said  to  be  mad.  And  the  reason  of  this  is 
that  madmen  do  not  necessarily  act  on  all  occasions  in  a 
different  manner  to  the  sane.  You  might  easily  pass 


160  INSANITY 

through  an  asylum  without  chancing  to  see  anyone  at  all 
whom  you  would  consider  insane,  and  yet  every  one  of  the 
patients  there  is  mad.  And  there  are  a  great  many  vari- 
eties of  the  disorder,  each  with  special  signs,  which  you  can 
only  recognize  when  you  have  been  taught  to  do  so.  This 
will  explain  how  it  is  that  madness  requires  special  study, 
and  why  it  is  that  madmen  must  be  kept  for  care  and  kind 
treatment  in  a  suitably-appointed  asylum,  and  submitted 
to  the  wholesome  routine  that  is  there  carried  out.  Those 
who  have  had  absolutely  no  experience  of  either  asylums 
or  the  insane  are  very  apt  to  think  that  it  is  terrible  to 
"lock  up"  an  insane  person  in  an  asylum;  but  no  kinder 
thing  can  be  done  to  a  madman  than  that.  And  for  these 
reasons : 

Nowadays  asylums  are  all  visited  by  officials  of  the 
Government  of  the  very  highest  standing,  and  it  is  their 
duty  to  report  on  what  they  see  in  asylums  for  all  the 
world  to  know.  At  the  head  of  every  asylum  is  a  physician 
of  special  knowledge  in  the  treatment  of  insanity.  Under 
him  are  other  physicians,  who  assist  him  and  train  the 
attendants,  so  that  the  patients  shall  not  be  in  the  care  of 
ignorant,  and  possibly  unkind,  men  and  women. 

The  utmost  care  is  taken  of  the  mad  people,  and  the 
physicians  report  on  their  condition  regularly  to  the  Govern- 
ment. As  soon  as  a  madman  recovers,  and  he  is  well 
enough  to  be  at  large,  he  is  discharged — a  free  man.  The 
rooms  and  corridors  are  warmed,  the  food  is  excellent,  and 
the  management  of  the  patients  is  in  skilled  hands.  So 
you  see  that  everything  is  done  to  alleviate  the  sadness  of 
madness.  Entertainments  are  provided,  and  in  some  places 
recovery  is  accelerated  by  giving  all  the  patients  suitable 
work  to  do ;  for  work  is  the  grandest  thing  to  keep  you  in 
good  mental  health.  The  lot  of  the  insane  person  at  the 
present  day  is  made  as  comfortable  as  possible;  formerly, 
as  I  have  shown,  the  mad  were  ill-treated,  as  if  they  were 
evil  or  criminal,  and  the  treatment  soon  made  them  both. 

But  while  we  may  congratulate  ourselves  on  our  growing 
knowledge,  wisdom  and  kindness  towards  the  unfortunate, 
we  are  possibly  too  lenient  and  forbearing — not  towards 
poor  suffering  mad  people,  but  towards  the  sane  as  well. 
For  a  lunatic  is  not  as  other  people  are,  even  if  he  recovers ; 
he  is  always  liable  to  relapses,  and  yet  when  free  of  the 
asylum  he  may  marry  and  have  children,  and  there  is 


INSANITY  161 

always  a  risk  that  he  will  transmit  to  them  some  taint  or 
other — madness,  alcoholism,  or  some  other  dread  disease. 

The  Varieties  of  Madness. — Insanity,  or  the  state  of  mad- 
ness, is  the  condition  of  unsoundness  of  mind  which  is  the 
opposite  to  sanity,  which  means  that  state  of  mind  which 
makes  men  and  women  able  to  carry  out  their  duties  to 
their  fellows,  and  to  behave  properly  in  their  own  interest. 
There  are  cases  of  insanity  of  very  different  forms,  and 
they  may  be  classed  and  considered  in  many  ways.  Infants 
may  be  born  mad,  and  are  then  called  idiots;  or  insanity 
may  come  on  at  every  period  of  life,  even  in  extreme  old 
age.  Indeed,  old  age  has  a  special  form  of  madness,  called 
Dementia,  or  a  return  to  a  childish  state  of  mind.  Insanity 
may  be  inherited  or  acquired.  Madness  certainly  runs  in 
some  families,  and  sometimes  comes  on  about  the  same  age 
and  in  similar  form  in  one  generation  after  another.  It 
can  be  acquired  by  head  injuries,  by  drunkenness,  by  de- 
bauchery, by  shocks  to  the  mind,  from  extreme  grief,  and 
from  horror.  Long-continued,  severe  pain  and  starvation 
will  also  send  people  mad.  A  long  series  of  epileptic  -fits 
may  end  in  insanity.  The  usual  forms  of  insanity  which 
occur  in  middle-life  to  persons  who  have  been  in  good  health 
are  three — Mania,  Melancholia,  and  Monomania.  Mania 
means  madness  in  which  violence  predominates,  or,  at  any 
rate,  the  form  in  which  patients  have  attacks  of  violence. 
It  is  called  raving  madness.  It  is  marked  by  loss  of  com- 
mon sense  and  memory,  with  delirium,  restlessness,  and 
sleeplessness,  self -neglect,  senseless  anger,  distrust  of  others, 
shouting  and  howling  for  hours  together.  The  maniac  is 
mischievous  and  destructive,  and  may  attack  others  or  kill 
himself.  Melancholia  comes  on  gradually,  with  depression 
of  spirits,  fear,  and  a  sullen,  morose  state  of  mind.  Such 
patients  seem  unwilling  to  say  or  do  anything,  and  sit  for 
hours  vacant-minded  or  in  mental  agony.  They  sometimes 
refuse  food,  and  try  to  starve  themselves,  and  may  attempt 
suicide  in  many  ways.  Melancholic  persons  may  also  de- 
velop murderous  tendencies,  and  sometimes  try  to  set  fire 
to  furniture  and  buildings.  The  worst  cases  of  melan- 
cholia are  those  which  begin  from  extreme  religious  devo- 
tion. Monomania  is  the  name  given  to  those  forms  of 
madness  in  which  the  patient  has  some  settled  delusion  or 
mental  crank,  and  may  yet  be  able  to  speak  and  act  sensibly 
in  ordinary  matters.  For  example,  monomaniacs  may  think 


162  PREVENTION  OF  INSANITY 

themselves  kings,  or  made  of  glass,  or  that  they  have  some 
divine  work  set  them  to  do. 

That  form  of  insanity  in  which  the  sufferer  has  constant 
fixed  delusions  is  called  paranoia.  This  is  one  of  the  com- 
monest forms  of  insanity  in  this  country. 

Treatment. — To  conceal  a  person's  insanity  is  to  commit 
an  action  which  is  both  unkind  to  the  patient  and  a  crime 
on  the  whole  public.  The  earliest  possible  removal  to  an 
asylum  is  of  the  utmost  importance,  and  every  day's  delay 
may  diminish  to  some  extent  the  chance  of  his  restoration 
to  health.  There  is  not  much  to  be  ashamed  of  in  having 
a  mad  person  in  the  family  as  a  drunkard,  for  instance ; 
but,  in  any  case,  asylum  treatment  is  his  only  chance  of 
recovery. 

Prevention  of  Insanity. — The  importance  of  preventing 
insanity  is  appreciated  when  it  is  realized  how  rapidly  in- 
sanity is  increasing — (104  per  cent,  during  the  last  decade 
in  New  York  State,  where  one-sixth  of  the  total  expenditure 
of  the  State  is  for  the  insane.) 

Insanity  is  due,  in  a  majority  of  cases,  to  causes  which 
are  known  and  preventable.  The  32,000  persons  now  in 
hospitals  for  the  insane  in  New  York  State  might  have 
remained  sane  and  lived  useful  and  happy  lives  if  they 
had  known  certain  facts  and  acted  accordingly. 

Of  the  preventable  causes  the  following  are  the  most 
important : — 

Immoral  living,  alcohol  and  other  poisons,  certain  physi- 
cal diseases,  bad  mental  habits  and  heredity. 

Immoral  living  is  extremely  liable  to  result  in  the  con- 
traction of  syphilis,  which  may  produce,  among  other  dis- 
eases, softening  of  the  brain — the  cause  of  25  per  cent,  of 
all  insanity.  Every  man  and  boy  should  know  that  by 
yielding  to  the  temptation  to  go  with  immoral  women  he  is 
exposing  himself  to  the  probability  of  getting  this  disease, 
which  may  result,  years  after,  in  incurable  insanity. 

Alcohol. — Forty  per  cent,  of  all  insane  cases  are  due 
directly  or  indirectly  to  alcohol  even  in  ' '  moderate ' '  quanti- 
ties not  producing  intoxication. 

Other  poisons  capable  of  producing  insanity  are  opium, 
morphine  and  cocaine. 

Physical  diseases  which  may  be  followed  by  insanity  are 
typhoid  fever,  influenza,  diphtheria,  tuberculosis,  and  dis- 
eases of  the  arteries,  heart  and  kidneys.  A  person  suffer- 


PREVENTION  OF  INSANITY  163 

ing  from  these  diseases  should  have  good  nursing,  skilled 
medical  treatment,  pleasant  surroundings  and  freedom 
from  anxiety.  Physical  diseases  may  be  prevented  or  con- 
trolled by  protection  of  food  and  water,  temperance,  health- 
ful homes  and  factories. 

Hard  work  alone  rarely  causes  a  nervous  breakdown. 
It  only  becomes  a  menace  to  health  when  associated  with 
worry,  loss  of  sleep,  etc. 

Bad  Mental  Habits. — The  healthy  state  of  mind  is  one 
of  satisfaction  with  life.  This  does  not  depend  so  much 
upon  our  surroundings  or  how  much  money  we  have,  as 
upon  the  way  in  which  we  train  ourselves  to  deal  with 
difficulties  and  troubles.  "  Stone  walls  do  not  a  prison 
make,  nor  iron  bars  a  cage." 

Anyone  who  departs  too  far  from  this  state  of  satisfac- 
tion must  be  regarded  as  tending  towards  an  unhealthy 
condition. 

The  average  person  little  realizes  the  danger  of  brooding 
over  slights,  injuries,  disappointments,  or  misfortunes,  or 
of  lack  of  frankness,  or  of  an  unnatural  attitude  towards 
his  fellowmen,  shown  by  unusual  sensitiveness  or  marked 
suspicion.  Yet  all  these  unwholesome  and  painful  trains 
of  thought  may,  if  persisted  in  and  unrelieved  by  healthy 
interests  and  activities,  tend  toward  insanity.  Wholesome 
work  relieved  by  periods  of  rest  and  simple  pleasures,  and 
an  interest  in  the  affairs  of  others,  are  important  pre- 
ventives of  unwholesome  ways  of  thinking. 

We  should  train  ourselves  not  to  brood,  but  to  honestly 
face  personal  difficulties.  We  may  not  like  even  to  admit 
the  existence  of  these  difficulties,  but  they  are  often  the 
real  cause  of  the  brooding.  To  start  doing  something,  to 
change  the  situations  about  which  we  fret,  is  the  healthiest 
way  to  avoid  aimless  fretting.  We  should  not  hanker  after 
the  impossible,  but  learn  to  get  satisfaction  from  what  is 
at  hand.  We  should  not  give  ourselves  up  to  day  dreaming, 
but  try  to  do  something,  no  matter  how  small  it  is. 

Heredity. — We  cannot  choose  our  parents,  but  we  can 
do  much  to  insure  the  health  of  our  offspring.  On  the 
other  hand  we  can  accomplish  much  by  not  worrying  un- 
duly about  insanity  in  our  ancestors.  Insanity  is  not  di- 
rectly inherited.  One  may  inherit  a  greater  or  less  tend- 
ency toward  insanity.  Mental  instability  may  be  inherited 
just  as  weak  constitutions  may  be  inherited. 


164  INSOMNIA 

Those  who  have  reason  to  believe  that  there  was  mental 
disease  in  their  ancestry  should  not  be  unduly  alarmed. 
The  fact  that  some  of  their  ancestors  suffered  from  mental 
trouble  does  not  make  it  certain  that  they  will  suffer  like- 
wise. These  tendencies  towards  insanity  may  lie  dormant 
during  the  whole  lives  of  the  individuals.  But  such  per- 
sons should  take  the  proper  precaution  to  prevent  the 
development  of  this  tendency.  As  a  weak  constitution  may 
be  built  up  by  healthful  habits,  so  may  mental  instability 
be  made  stable  by  good  mental  and  physical  habits.  The 
individual  whose  family  has  bad  mental  trouble  may  often 
escape  the  disease  by  proper  surroundings,  healthful  and 
temperate  activities,  and  proper  mental  and  physical  habits. 
The  most  important  fact  in  heredity  is  that  the  vast  ma- 
jority of  ancestors  of  every  individual  were  normal. 

Heredity  tends,  therefor,  rather  more  strongly  toward 
health  than  toward  disease. 

The  fact  that  heredity  plays  a  part  in  the  causation  of 
insanity,  should  create  a  public  conscience  regarding  mar- 
riage. Marriages  should  not  be  contracted  by  two  persons 
who  have  insanity  or  feeble-mindedness  in  their  immediate 
families,  without  first  seeking  the  advice  of  a  competent 
physician. 

Insomnia. —  (SLEEPLESSNESS.) — No  one  can  remain  many 
days  without  sleep,  but  many  persons  do  not  sleep  so  long 
as  they  would  like  to,  and  many  persons  do  not  sleep  as 
much  as  their  health  needs.  The  doctors  describe  a  special 
form  of  disease  named  insomnia,  which  means  wakefulness 
occurring  when  sleep  ought  to  be  present.  It  may  be  due 
to  disease  of  the  mind,  or  of  the  brain,  or  of  the  body,  and 
may  itself  give  rise  to  other  diseases.  Absence  of  sleep 
is  very  rarely  complete  even  for  twenty-four  hours,  but 
want  of  quiet,  restful,  continuous  sleep  is  a  state  from 
which  most  people  suffer  at  some  time  or  other.  It  is  very 
well  known  that  there  are  drugs  which  will  produce  sleep, 
or,  at  any  rate,  will  bring  on  insensibility,  or  a  form  of 
sleep,  and  these  drugs  are  called  sedatives  or  narcotics. 
It  is,  however,  very  bad  policy  to  give  any  doses  of  such 
medicines  until  you  have  tried  the  removal  of  all  possible 
causes  for  the  wakeful  state,  because  in  most  patients  there 
is  some  definite  cause  for  it,  and  when  the  cause  is  taken 
away  the  patient  sleeps  well.  Sedative  doses  strong  enough 
to  compel  sleep  should  be  avoided  also  because  they  dis- 


INSOMNIA  165 

order  the  stomach,  disturb  the  digestion,  make  the  tongue 
dry  and  coated,  and  cause  an  unnatural  thirst ;  the  appetite 
is  also  lost.  Sleeplessness  may  show  the  presence  of  fever; 
it  may  be  due  to  pain,  to  shortness  of  'breath,  to  palpitation 
of  the  heart,  or  to  delirium,  especially  the  delirium  of 
drunkards.  Simple  sleeplessness  does  sometimes  occur  in 
the  absence  of  any  of  these  serious  causes;  it  may  be  due 
to  a  state  of  worry  or  irritability  of  the  mind,  pointing  to 
a  congestion  of  the  brain.  Some  forms  of  indigestion  will 
cause  it,  and  in  this  matter  people  vary  very  much,  for  some 
cannot  sleep  after  a  heavy  supper,  while  others  lie  awake 
if  they  have  an  empty  stomach.  Persons  who  lead  lives  of 
bodily  work  carried  on  in  the  open  air  generally  sleep  very 
soundly,  while  persons  who  work  in  the  close,  unhealthy 
rooms  in  factories  often  have  restless  nights.  Over-fatigue 
may  cause  restlessness,  and  so  anxiety  of  mind  can  destroy 
all  chances  of  sleeping.  Literary  workers,  and  also  persons 
who  lead  useless,  frivolous  lives,  often  sleep  very  lightly, 
and  go  to  doctors  for  sedatives. 

But  all  attempts  at  classifying  the  causes  of  sleeplessness 
are  very  unsatisfactory,  and  the  subject  might  be  dealt 
with  adequately  only  in  a  couple  of  thick  volumes.  We 
have  mentioned  above  eight  of  the  commonest  causes  of 
sleeping  badly.  Others  are  cold  feet,  tea-drinking  at  bed- 
time, lack  of  food,  heart  disease.  The  first  thing  to  do, 
then,  if  you  sleep  badly,  is  to  find  out  why.  Have  your 
room  dark  and  quiet,  and  see  that  your  feet  are  warmed. 
(See  also  "Sleep,  Hints  on  Obtaining,"  in  this  volume.) 

When  we  come  to  consider  drugs  we  tread  on  dangerous 
ground.  The  people  who  suffer  most  from  sleeplessness 
are  not  those  who  do  some  work  in  life,  and  fill  their  hours 
in  some  profitable  way,  but  they  are  those  who  idle  and 
lounge,  or  live  frivolously,  and  those  who  drink  and  eat 
too  much.  These  people  are  already  self-indulgent,  and  to 
tell  them  to  drink  a  little  alcohol,  or  to  take  a  little  narcotic 
at  bedtime,  is  only  to  give  them  an  excuse  for  another  bad 
habit.  Chloral,  morphine,  alcohol,  and  the  rest,  spoil  a 
good  many  lives  from  over-indulgence.  The  most  harmless 
sedatives  are  the  bromides,  which  may  be  taken,  if  neces- 
sary, for  years.  Thirty  grains  of  bromide  of  ammonium 
should  be  taken  an  hour  before  bedtime  in  mild  cases  of 
sleeplessness,  and  until  this  plan  has  been  given  a  good 
trial,  no  other  sedatives  should  be  used.  A  very  safe  drug 


166  ITCHING 

is  bromural  in  a  dose  of  10  grains,  taken  in  a  little  hot 
water  and  sugar  at  bedtime. 

Itch  is  a  skin  disease  caused  by  the  presence  of  a  species 
of  mite  which  lives,  male  and  female,  on  the  skin,  and 
burrows  into  it.  The  female  itch-insect  leaves  her  eggs  in 
the  burrows  and  they  set  up  an  intolerable  itching  and 
irritation.  The  commonest  places  for  these  burrows  are 
the  webs  between  the  fingers  and  toes,  the  front  of  the 
wrists,  and  women's  breasts;  and  never  are  they  seen  on 
the  face,  except  sometimes  on  children  in  arms.  There  is 
generally  a  little  tiny  pimple  which  marks  the  mouth  of 
each  burrow,  and  a  little  track  can  generally  be  traced  by 
the  thin  line  of  dirt  which  fills  it.  So  that  almost  anyone 
can  discover  the  signs  of  the  presence  of  the  insect.  If  you 
rub  weak  sulphur  ointment  into  the  burrows  so  thoroughly 
as  to  get  into  every  cranny  and  nook,  for  a  few  days,  the 
insects  will  die,  and  the  disease  will  be  cured.  But  in 
cases  where  the  itch  occurs  on  parts  of  the  body  which  are 
covered  up,  disinfection  of  the  clothes  must  be  undertaken, 
and  the  patient  must  take  baths,  and  use  soaps  and  lotions 
which  must  be  ordered  by  the  doctor  according  to  the  merits 
of  the  particular  case.  So  far,  so  good.  But  many  people 
who  contract  the  itch  scratch  the  skin  wildly,  and  as  the 
finger-nails  are  not  always  clean,  the  scratched  skin  soon 
has  a  number  of  sore  places  on  it,  all  more  or  less  "poi- 
soned" by  the  patient  himself,  who  very  likely  spreads  the 
disease  all  over  his  body  by  mere  scratching.  With  regard 
to  the  cure  we  must  say  that  mere  smearing  of  the  ointment 
on  the  place  is  of  no  use ;  on  the  other  hand,  you  need  not 
be  so  vigorous  as  to  inflame  the  skin  with  it.  If  there  is 
only  itch,  you  may  cure  it  with  stavesacre  ointment,  or  weak 
sulphur  ointment,  after  a  hot  bath,  in  which  use  soft  soap. 
For  the  itching  a  lather  of  menthol  soap  is  the  best  thing. 
But  where  the  skin  has  been  rudely  scratched,  and  is  a  mass 
of  tender  places  and  sores  and  scabs,  it  is  a  case  for  the 
personal  attention  of  a  doctor. 

Itching  of  the  Skin  of  Various  Parts. — There  are  two  dis- 
tinct ailments  in  which  the  sufferer  complains  of  itching  of 
the  skin.  One  is  prurigo,  a  non-contagious  skin-eruption 
of  small  pimples,  causing  intense  suffering,  and  very  diffi- 
cult to  relieve.  It  has  nothing  to  do  with  the  disease  called 
the  itch,  and  is  really  a  disease  of  old  age  and  caused  in 
some  mysterious  way  by  the  slow  * '  decay ' '  of  the  skin  itself. 


ITCHING  167 

This  ailment  we  shall  say  no  more  about.  The  other  ail- 
ment, which  must  not  be  mixed  up  with  prurigo,  is  called 
pruritus,  and  means  "an  itching." 

Pruritus  is  not  a  disease,  nor  is  it  a  skin-eruption,  but 
only  a  sign  or  irritation  of  the  skin  caused  by  something 
which  it  is  the  doctor's  duty  to  find  out  before  he  can  set 
to  work  to  relieve  it.  The  causes  of  the  itchiness  of  the 
skin  which  we  call  pruritus  are : — 

(a)  Local  causes — 

(1)  Dirty  habits;  lack  of  washing. 

(2)  Lousiness  (see  "Lice"). 

(3)  Ringworm. 

(4)  Eczema. 

(5)  Irritating  woolen  underclothing. 

(6)  "Prickly  heat"  (a  sweat  eruption  which  some 
people  get  in  very  hot  weather) . 

(b)  General  causes — 

(1)  Diabetes  (which  see). 

(2)  Jaundice. 

(3)  Piles,  which  cause  much  itching  at  the  anus. 

(4)  Diseases  of  the  womb  often  cause  itching  due  to 
the  irritating  discharges. 

(5)  Pregnancy.     Many  women  have  terrible  itching 
towards  the  end  of  child-bearing. 

(6)  The  change  of  life  in  women  (see  "Change  of 
Life"). 

(7)  Worms  in  the  intestines. 

Now,  whatever  be  the  cause  of  the  itchiness,  it  gets  worse 
when  the  patient  gets  warm  in  bed. 

Treatment. — First,  insist  on  thorough  cleanliness  and 
bathing.  Eczema,  if  present,  wants  special  treatment  (see 
"Eczema").  Diabetic  itching  is  relieved  by  sponging  the 
parts  daily  with  Goulard  lotion.  Or  the  following  may  be 
painted  on  with  a  brush — menthol,  1  part ;  olive  oil,  5  parts. 

Baths  are  especially  comforting  to  itchy  skins. — The  co- 
nium  and  starch  bath — Extract  of  conium,  120  grains; 
starch  powder,  lib.;  hot  water,  30  gallons.  (After  this 
bath,  sprinkle  the  skin  with  starch  powder.) 

The  Sulphuret  bath — Sulphuret  of  potash,  4  ounces ;  hot 
water,  30  gallons. 


168  KIDNEY  DISEASES 

Caution. — Not  to  be  taken  if  there  be  sore  places  from 
scratching. 

Kidney  Diseases. — The  kidneys  are  two  organs  lying  in 
the  lower  part  of  the  back  (the  loins),  and  their  duty  is 
to  get  rid  of  the  waste  matters  in  the  blood.  The  water 
which  the  kidneys  secrete  passes  down  two  little  tubes  into 
the  bladder  and  remains  in  the  bladder  until  that  vessel 
is  uncomfortably  full  when  it  is  passed  away  through  the 
urethra  or  pipe. 

A  healthy  person  passes  about  fifty  ounces  (two  and  a 
half  pints)  of  urine  every  day.  In  cold  weather,  more ;  in 
hot  weather,  less,  because  the  skin  gets  rid  of  a  lot  of  water 
by  perspiration.  Healthy  urine  is  pale  amber-colored  and 
has  no  deposit.  But  let  none  of  our  readers  pay  too  much 
attention  to  the  urine.  It  varies  very  much  in  color  and 
in  quantity  even  in  good  health.  A  pinkish  sediment  in 
urine  that  has  been  standing  and  has  got  cool  in  the  cham- 
ber, is  very  common,  and  is  of  no  importance.  It  probably 
means  that  you  have  a  slight  cold,  or  that  you  are  eating 
too  much  meat.  Many  medicines  color  the  urine;  rhubarb 
makes  it  very  yellow,  asparagus  makes  it  smell  aromatic- 
ally;  and  so  on.  If  the  state  of  your  urine  troubles  you, 
take  a  little  bottle  of  it  to  a  doctor  and  ask  his  opinion. 
Don't  take  "  kidney  pills,"  or  other  self -prescribed  medi- 
cines. And  don't  run  away  with  the  idea  that  a  pain  in 
the  back  necessarily  means  kidney  disease,  as  certain  ad- 
vertisements try  to  make  you  believe.  The  pain  may  be 
kidney  trouble,  but  probably  is  not.  (See  also  "Lum- 
bago.") 

The  kidneys  are  subject  to  inflammations  of  various  kinds. 
The  acute  inflammations  are  serious  acute  illnesses,  and 
must  be  treated  by  the  doctor.  Nothing  is  to  be  gained  by 
a  long  description  of  these  diseases. 

Inflammation  of  the  kidneys  ( Bright 's  disease)  produces 
certain  signs  and  symptoms  which  the  reader  ought  to  know 
something  about. 

(1)  Smoky  urine. — When  the  urine  looks  as  if  it  had 
been  mixed  with  smoke,  it  probably  contains  blood.     Take 
some  of  it  to  the  doctor  at  once. 

(2)  Dropsy. — The  eyelids  are  puffy  when  the  patient 
rises  from  bed  in  the  morning.     The  ankles  are  puffy  at 
bedtime.     If  the  finger  is  pushed  into  this  puffy  swelling 
it  leaves  a  pit ;  the  flesh  seems  to  be  "  boggy, ' '  and  is  water- 


KIDNEY  DISEASES  169 

logged,  as  the  saying  is.  These  signs,  seen  in  a  person  who 
has  had  scarlatina,  means  kidney  trouble.  In  middle-aged 
persons  who  have  damaged  their  kidneys  by  drunkenness, 
this  dropsy  is  common. 

(3)  In  kidney  disease  the  heart  and  pulse  beat  hard  and 
strong,  and  the  patient  is  liable  to  giddiness  and  vomit- 
ing. 

Chronic  Bright 's  Disease. — This  is  of  two  chief  varieties. 
Persons  who  have  had  syphilis,  or  malaria  or  gout,  and 
those  who  work  in  lead,  are  especially  liable  to  these  forms 
of  kidney  decay.  But  the  chiefest  cause  of  all  chronic 
kidney  disease  is  intemperance.  The  early  signs  of  chronic 
kidney  disease  are  anemia,  loss  of  appetite,  headaches, 
sickness,  general  weakness,  passing  too  much  urine  (es- 
pecially having  to  get  up  in  the  night  to  pass  it),  and 
dropsy,  as  before  described.  The  disease  generally  pro- 
gresses until  the  patient  gets  an  attack  of  paralysis,  or 
several  attacks,  and  then  heart  disease,  and  then  death. 
But  much  may  be  done  by  a  doctor's  careful  treatment, 
warm  clothing,  and  especially  by  total  abstinence  from 
alcohol.  Alcohol,  in  fact,  is  a  powerful  poison  when  the 
kidneys  are  diseased.  Meat  must  be  given  up  as  far  as 
possible,  and  the  diet  be  confined  to  milk  and  farinaceous 
foods. 

The  treatment  of  some  of  the  symptoms  of  chronic 
Bright 's  disease,  or  chronic  nephritis  (degeneration  or  de- 
cay of  the  kidney  tissues),  is  here  given: — 

For  sleeplessness — 

(1)  Sulphonal,   20  grains,  in  cachet.     (To  be  swal- 
lowed at  bedtime,  and  washed  down  with  a  half-pint  of 
hot  water.)     Or, 

(2)  Paraldehyde,    1    drachm;    water,    a   wineglassful. 
(At  bedtime.)  Or, 

(3)  Trional,  5  grains  in  cachet.     (To  be  swallowed  an 
hour  before  retiring.) 

Note. — Chloral,    opium   and   morphine   must   not   be 
taken. 

For  headache — 

(1)   Caffeine,  5  grains;  antipyrin,  2  grains.     (To  be 
taken  whenever  the  headache  is  violent.) 


170  LEAD  POISONING 

For  smoky  urine — 

(1)  Nitrate  of  pilocarpine,  4  grains;  vaseline,  12 
ounces.  (To  make  an  ointment,  about  3  ounces  of  which 
are  to  be  daily  rubbed  well  into  the  skin  and  covered 
with  cotton  wool,  and  bandage.) 

For  dropsy — 

General  measures — massage,  hot-air  baths,  purgatives. 
For  vomiting — 

(1)  Real  buttermilk,  1  ounce;  potash  water,  7  ounces. 
(To  be  taken  as  a  draught  occasionally.) 

(2)  Iced  champagne. 

Koumiss,  Home-made. — A  stimulating,  nourishing,  and 
refreshing  food  and  drink  for  persons  with  diabetes,  and 
others  with  indigestion.  //  buttermilk  can  be  got,  mix  two 
pints  of  it  thoroughly  with  three  pints  of  milk,  and  add 
five  lumps  of  white  sugar.  Put  the  milk  in  a  bowl,  covered 
with  a  clean  towel,  and  let  it  stand  in  a  warm  corner  for 
24  hours.  Then  pour  it  into  small  bottles,  cork  them,  and 
tie  down  with  corks.  Leave  the  bottles  in  the  kitchen  three 
days  lying  on  their  sides  and  shake  them  occasionally. 
After  this  the  koumiss  is  ready  for  use. 

//  buttermilk  cannot  be  got. — Boil  enough  fresh  milk  to 
fill  a  few  quart  bottles  when  cold,  not  filling  the  bottles 
completely,  but  leaving  room  to  shake.  Add  to  each  bottle 
half -ounce  of  castor  sugar,  and  20  grains  of  Vienna  yeast ; 
cork  the  bottles  up  with  sound  corks  and  tie  down.  Lay 
the  bottles  horizontally  on  the  floor  in  a  warm  corner, 
and  shake  twice  a  day.  The  koumiss  will  be  ready  to 
drink  on  the  sixth  day  (sooner  in  hot  weather  and  later 
in  cold.)  Can  be  made  thinner  by  using  skimmed  milk. 
—  (Yeo.) 

Lead  Poisoning. — This  occurs  chiefly  among  painters, 
plumbers,  compositors,  type-founders,  and  factory-hands 
in  white  lead  factories  and  potteries.  Those  who  drink 
beer  to  excess  are  more  liable  than  others. 

Poisoning  by  lead  may  be  known  by  attacks  of  colic, 
ancemia,  gouty  attacks,  a  blue  line  on  the  gums,  paralysis, 
and  headaches,  and  cramps  and  numbness,  and,  in  women, 
abortions.  The  colic  attacks  are  very  severe;  the  pain  is 


LICE  171 

relieved  a  little  by  pressure  and  a  tight  belt.  The  patient 
is  constipated,  and  often  vomits  before  the  colic  begins. 
The  anaemia  is  often  the  first  sign  (see  also  "Anaemia"). 
The  "blue  line"  is  not  to  be  seen  in  persons  who  brush 
the  teeth  regularly.  The  paralysis  is  in  the  form  of  wrist 
drop — the  patient's  hands  hang  down  and  he  cannot  raise 
them. 

The  poisoning  is  curable,  but  will  come  on  again  if  the 
patient  does  not  give  up  his  unhealthy  occupation.  The 
colic  yields  to  opium,  but  a  doctor  must  be  consulted  about 
that.  All  the  signs  of  poisoning  will  disappear  at  last  if 
the  patient,  having  changed  his  employment,  will  take,  for 
three  months,  or  more,  as  the  case  may  be,  some  such  medi- 
cine as  the  following: — Iodide  of  sodium,  40  grains;  sul- 
phate of  magnesia,  one  ounce ;  tincture  of  nux  vomica,  two 
drachms ;  cinnamon  water  to  eight  ounces.  Take  two  table- 
spoonfuls,  on  rising  and  at  bedtime,  for  three  months. 

Lice  (VERMIN)  are  not  uncommon  on  the  bodies  or 
among  the  hairs  of  persons  who  are  not  of  cleanly  habits. 
A  louse  is  a  tiny  insect  looking  a  little  like  a  tiny  crab, 
and,  in  fact,  the  word  ' '  crab ' '  is  often  used  to  refer  to  such 
lice.  The  louse  lives  on  the  skin  and  feeds  on  the  blood  of 
the  dirty  person  who  harbors  it.  The  presence  of  several 
lice  causes  itching,  and  as  the  person  scratches  with  dirty 
finger-nails,  he  infects  the  little  louse  wounds  with  dirt,  and 
thus  he  gets  a  sort  of  skin  disease.  The  whole  business  is 
all  the  more  disgusting  because  it  could  be  entirely  avoided 
by  keeping  the  skin  clean.  In  a  bad  case,  a  neglected  child 's 
skin  or  scalp  becomes  covered  with  dirty  sores  and  crusted 
scabs;  on  the  hairs  near  will  be  found  "nits,"  tiny  eggs, 
which  are  glued  to  the  hairs,  and  cannot  be  got  off  by  or- 
dinary washing.  Later  on  the  glands  in  the  neighborhood 
become  swollen  and  form  painful  lumps,  which  may  become 
abscesses. 

Whenever  a  child's  head  is  always  itching,  and  there 
are  scabs  on  it,  and  a  few  little  lumps  on  the  neck,  the  child 
probably  has  lice,  and  we  ought  to  look  for  the  nits,  which 
are  gummed  to  the  hairs.  First  cut  the  hair  short,  and 
burn  it.  Burn  also  the  cap  or  hat  that  he  has  been  wear- 
ing, and  send  his  towel  and  pillow-case  to  the  wash.  Then 
rub  into  the  scalp  white  precipitate  ointment. 

Vinegar  and  water  will  destroy  nits,  used  as  a  lotion 
after  washing  the  head  thoroughly.  A  good  lotion  for  lice 


172  ARTIFICIAL  LIGHTING 

consists  of  1  grain  perchloride  of  mercury,  1  drachm  spirits 
of  rosemary,  and  dilute  acetic  acid  up  to  1  ounce. 

Elderly  people  of  dirty  habits  often  complain  of  an  itch- 
ing skin,  and  if  the  folds  of  the  shirt  or  chemise  near  the 
neck  be  closely  examined,  lice  may  be  found.  In  such  a 
case  the  clothes  must  be  disinfected  as  well  as  washed,  and 
that  may  be  done  by  baking  them. 

Lighting. — The  illumination  of  a  room  is  a  matter  greatly 
affecting  the  comfort  and,  indirectly,  the  health  of  the 
occupants,  and  is  of  especial  importance  to  eyesight  in 
the  case  of  factories,  workshops  and  schools,  where  the 
eyes  are  concentrated  on  small  objects  for  many  hours  at 
a  time. 

The  difference  between  good  lighting  and  darkness  is 
the  difference  between  cheerfulness  and  gloom.  It  vastly 
increases  the  efficiency  of  the  worker;  it  obviates  eyestrain 
and  the  development  of  myopia.  Good  natural  lighting 
aids  cleanliness,  destroys  germs  and  their  dangerous  prod- 
ucts and  influences  directly  the  health  of  the  body.  Just 
how  light  acts  in  this  way  is  not  definitely  known  but  it 
is  a  well-proven  fact.  Some  direct  evidence  comes  from 
the  recognized  effect  of  ultra-violet  rays  and  the  Finsen 
light  on  certain  disease  processes  on  the  surface  of  the 
body. 

The  best  illuminant  is  sunlight.  The  best  artificial  illum- 
inants  are  those  which  most  closely  resemble  sunlight. 
All  sources  of  light  should  be  shaded  and  the  best  form 
of  illumination  is  that  known  as  the  * '  indirect ' '  where  light 
is  reflected  from  a  broad  light  surface. 

An  important  aid  to  the  illumination  of  dark  interiors  by 
natural  light  has  been  the  recent  introduction  of  panes  or 
plates  of  glass  with  a  series  of  ridges  or  prisms,  which  re- 
fract and  diffuse  throughout  a  room  light  which  would 
otherwise  illuminate  it  but  partially  or  not  at  all. 

ARTIFICIAL  LIGHTING— of  all  the  systems  of  arti- 
ficial lighting  in  common  use  at  the  present  time  the  in- 
candescent electric  light  should  be  placed  in  the  first  rank, 
followed  next  by  the  incandescent  gas-light  (Welsbach). 

The  Incandescent  electric  light  presents  the  following 
advantages  over  coal  gas,  oil  and  candles.  There  is  no 
consumption  of  oxygen,  there  are  no  products  of  com- 
bustion to  pollute  the  air,  and  the  heat  produced  is  rela- 
tively slight.  The  light  of  the  arc  light  is  not  yellow,  but 


ARTIFICIAL  LIGHTING 


173 


white.  It  precisely  resembles  solar  light  in  being  rich  in 
the  violet  and  the  ultra-violet  rays.  Plants  grow  and  flower, 
and  fruit  ripens,  when  exposed  to  this  light,  just  as  they 
do  in  the  sunlight;  whilst  photographs  can  be  taken  as 
easily  by  the  arc  electric  light  as  by  daylight. 

The  arc  light,  while  well  adapted  for  lighting  streets, 
large  halls  and  buildings,  is  extremely  dazzling,  and  is 
productive  of  injurious  effects  on  the  eyes  of  those  who  are 
much  exposed  to  its  influence  unless  it  is  extremely  well 
shaded. 

The  incandescent  lamps  are  best  suited  for  domestic  use. 
The  light  is  steady  and  agreeable,  but  should  always  be 
shaded  or  used  as  a  diffused  indirect  light. 

Modern  economical  forms  of  electric  lighting  for  work 
rooms  and  halls  are  the  mercury  vapor  tubes  used  in  the 
Cooper-Hewitt  and  the  Moore  systems.  In  the  Cooper- 
Hewitt  light  the  red  rays  are  absent  and  human  beings 
have  the  complexion  of  death.  The  light  is  a  very  good 
one  to  work  by,  however.  The  Moore  light  has  a  more 
agreeable  yellow  or  pink  rose  color. 

The  Welsbach  light  is  less  productive  of  carbon  dioxide 
than  the  average  oil  lamp  and  consumes  not  quite  one-half 
less  gas  than  the  ordinary  gas  burners,  giving  rise,  there- 
fore, to  the  evolution  of  half  the  heat  and  half  the  amount 
of  carbon  dioxide,  while  its  illuminating  power  expressed 
in  candles  is  more  than  three  times  as  great  as  the  best 
ordinary  gas  burners  or  incandescent  electric  light. 

The  important  attributes  of  an  illuminant,  from  the 
health  standpoint,  are  the  following: — amount  of  ogygen 
removed  from  the  air,  the  amount  of  carbon  dioxide  pro- 
duced, the  amount  of  heat  produced  and  the  degree  of 
vitiation  of  the  atmosphere. 

The  following  table  shows  these  points  for  the  com- 
moner forms  of  illuminations : — 


Candle 
power 

Oxygen 
removed 

Carbon 
dioxide 
produced 

Heat 
calories 
produced 

Vitiation 
equal  to 
adults 

Tallow  candle  .... 
Kerosene  oil  lamp  . 
Coal-gas  burner    .  . 
Welsbach  burner  .. 
Electric     incandes- 
cent light 

16 
16 
16 
50 

16 

cu.  ft. 
10.7 
5.9 
6.5 
4.1 

0.0 

cu.  ft. 

7.3 

4.1 
2.8 
1.8 

0.0 

1400 
1030 
1194 
763 

37 

12 
7 
5 
3 

0.0 

174  LIVER,  DISEASES  OF  THE 

Acetylene  gas,  generated  by  the  action  of  carbide  on 
water,  furnishes  a  powerful  white  light;  but  its  use  is  not 
unattended  with  danger,  unless  great  care  is  exercised. 

Coal  gas  gives  a  yellow  or  orange  flame  which  is  usually 
steady  and  agreeable  although  there  are  certain  drawbacks 
connected  with  its  use.  It  consumes  much  oxygen,  pro- 
duces carbon  dioxide,  produces  much  heat  and  vitiates  the 
atmosphere  considerably.  Leaky  gas  pipes  are  dangerous. 
The  products  of  combustion  are  injurious  to  health.  The 
combustion  dries  the  air  and  the  humidity  is  much  lowered. 

Each  cubic  foot  of  gas  burnt  per  hour  from  ordinary 
burners  vitiates  as  much  air  as  would  be  rendered  impure 
by  the  respiration  of  an  individual. 

Kerosene  oil  lamps  are  well  fitted  for  use  in  rural  com- 
munities. The  fuel  is  cheap  and  the  light  a  steady  one, 
and  agreeable  if  properly  shaded.  They  vitiate  the  air 
greatly  and  produce  a  great  deal  of  heat,  as  well  as  consume 
much  oxygen  and  produce  much  carbon  dioxide.  Their  use 
is  sometimes  attended  with  danger  from  explosion  and  fire, 
but  modern  lamps  are  made  in  which  explosions  are  im- 
possible, and  there  are  lamps  which  become  extinguished 
automatically  when  they  are  upset. 

Tallow  candles  are  the  poorest  of  the  common  forms 
of  illuminants.  The  light  is  flickering,  weak,  too  yellow 
and  sooty.  Much  gas  and  heat  are  produced,  the  vitiation 
of  the  air  is  great,  much  oxygen  is  consumed  and  the  amount 
of  carbon  dioxide  produced  is  large. 

Liver,  Diseases  of  the. — The  liver,  which  is  a  very  large 
gland,  lying  chiefly  on  the  right  side,  below  the  lung,  and 
beneath  the  lower  ribs,  has  for  its  principal  duty  the  for- 
mation of  a  digestive  fluid  called  bile  or  gall,  which  is  stored 
up  in  the  gall-bladder  on  the  under  surface  of  the  liver, 
and  is  poured  out  drop  by  drop  into  the  gut  or  bowel  so 
that  it  may  mix  with  the  food  and  digest  it.  To  digest 
food  means  to  prepare  it  for  absorption  into  the  blood. 
The  liver  has  other  work  to  do  also,  but  the  making  of  the 
all-important  bile  is  its  chief  industry.  Now  bile  not  only 
helps  in  the  digestion  of  the  food,  but  it  is  a  natural  dis- 
infectant, and  a  natural  purgative,  helping  the  lowest  parts 
of  the  bowel  to  get  rid"  of  the  waste  matters.  It  is  now 
easy  to  see  why  a  stoppage  in  the  formation  of  bile  leads 
to  costive  bowels,  and  to  indigestion. 

Like  every  other  part  of  the  body,  the  liver  is  subject 


CIRRHOSIS  OF  THE  LIVER  175 

to  congestion  and  inflammation.  Acute  inflammation  of 
the  liver  is  caused  by  excess  of  alcoholic  drinking,  indis- 
cretions in  diet,  etc.,  and  requires  rest  in  bed.  The  patient 
is  a  little  feverish,  the  liver  is  tender,  the  whites  of  the 
eyes  are  yellowish,  the  motions  are  pale  colored,  the  urine 
high-colored,  and  he  has  a  headache  and  languid  feeling. 
A  light  milk  diet  will  be  needed,  and  a  three-grain  dose 
of  calomel;  and  a  hot  linseed  and  mustard  poultice  must 
be  put  on  over  the  liver  and  replaced  when  cold  by  a  thick 
layer  of  cotton-wool.  The  attack  generally  lasts  about  a 
week. 

Chronic  inflammation  of  the  liver  results  from  heart- 
disease  of  certain  kinds,  and  this  is  the  patient's  sad  mis- 
fortune; the  chronic  enlargement  of  the  liver  due  to  al- 
coholic excess  is  more  common  and  is  the  patient's  fault. 
Its  cure  depends  very  largely  on  the  patient  himself.  The 
chronic  enlargement  is  called  cirrhosis  (pronounced  sir- 
rosis)  of  the  liver.  The  symptoms  of  it  are  also  those 
of  chronic  indigestion  caused  by  alcohol,  because  it  is  al- 
ways accompanied  by  inflammation  of  the  stomach.  The 
chief  signs  are  trembling  and  coated  tongue,  shakiness  of 
the  hands,  enlarged  veins  over  nose  and  cheeks,  sickness  on 
rising  in  the  morning,  loss  of  appetite,  a  dry  taste  in  the 
mouth,  sleeplessness.  Later  on,  piles  and  blood-vomiting 
(which  see )  ;  watery  eyes,  muddy  complexion,  fat  body, 
thin  legs  and  arms. 

Most  of  these  drunkards,  suffering  thus  from  years  of 
folly  and  self-indulgence,  are  weakened  from  long  absti- 
nence from  food,  and  a  slight  nutritious  slop  diet  is  one 
of  the  first  necessities.  But  Nature  will  recover  herself 
largely  without  much  treatment  if  only  the  alcohol  is  given 
up  absolutely  and  at  once.  Change  of  occupation  is  of 
vital  importance  for  waiters,  publicans,  and  barmaids  who 
have  developed  the  disease.  Outdoor  labor  should  be 
tried. 

Cirrhosis  of  the  Liver  has  very,  very  numerous,  pain- 
ful and  distressing  symptoms.  We  cannot  here  attempt 
a  thorough  exposition  of  the  treatment  necessary.  When 
the  disease  is  definitely  developed  the  patient  will  require 
continuous  medical  aid  as  well  as  his  own  efforts  at  keep- 
ing sober.  The  following  medicine  will  help  him  to  resist 
the  craving  for  drink  and  will  do  his  indigestion  good:— 
Taraxacum  juice,  2  ounces;  dilute  nitre-hydrochloric  acid, 


176  LOCOMOTOR  ATAXY 

%  ounce;  tincture  of  mix  vomica,  6  drachms;  liquid  ex- 
tract of  Cinchona  bark,  4  drachms;  water  to  12  ounces. 
Take  a  tablespoonful  in  a  wineglassful  of  water  before 
meals. 

Cancer  of  the  Liver. — This  generally  occurs  in  the  in- 
temperate, but  a  secondary  growth  in  the  liver  may  happen 
to  anybody  with  a  cancer.  (See  "Cancer.") 

Liver  Colic. — This  is  the  pain  caused  by  the  passage  of 
a  gallstone  which  is  forced  from  the  gall-bladder  where  it 
was  formed,  through  a  narrow  tube  too  small  for  it,  into 
the  gut.  The  pain  is  sudden  and  intense  and  is  felt  in 
the  lower  part  of  the  chest,  the  right  shoulder  and  back. 
It  is  often  so  severe  that  the  wretched  man  (or  more  often 
woman)  is  bent  double  in  agony  and  writhes  about  on  the 
floor,  shivering,  sweating  and  miserable.  After  a  time  the 
pain  becomes  less,  and  dull  and  aching  until  it  all  sub- 
sides— or  a  fresh  attack  occurs. 

Very  often  the  patient  gets  yellow  all  over,  jaundiced. 
The  whites  of  the  eyes  are  the  first  to  show  the  yellowness 
and  the  last  to  lose  it.  If  the  gallstone  passes  into  the 
gut,  the  pain  all  goes  away,  the  jaundice  gets  better  and 
the  little  stone  is  passed  away  in  the  motions.  But  the 
stone  may  remain  in  the  little  tube,  unable  to  get  out. 

The  actual  attack  of  pain  must  be  treated  by  a  medical 
man.  Afterwards  the  patient  must  take  precautions  against 
the  formation  of  another  stone.  The  diet  must  be  spare, 
plenty  of  exercise  must  be  taken  and  alkaline  drinks  must 
be  taken  in  large  quantities  always.  Also  the  patient  must 
take  a  heaped-up  teaspoonful  of  phosphate  of  soda  in  hot 
water  every  morning. 

Hot  baths  or  hot  poultices  are  useful  for  the  attacks  of 
pain,  until  medical  advice  can  be  obtained. 

Lockjaw.     (See  "Tetanus.") 

Locomotor  Ataxy. — A  nervous  disease,  chronic,  progres- 
sive, ending  in  death  in  a  few  years.  Most  common  in 
middle-aged  men,  especially  fast  men,  who  have  had 
syphilis,  and  who,  in  addition,  are  given  to  drinking  alcohol 
in  excess. 

There  are  three  stages  to  the  disease: — 

(1)  The  Pre-ataxic  stage.  (Ataxy  means  inability  to 
control  muscular  movements.) — Some  of  the  signs  and 
symptoms  in  this  stage  are: — "lightning-pains"  (acute, 
severe  and  violent  sudden  pains  lasting  a  few  seconds) ; 


LUMBAGO  177 

"girdle-pain,"  a  sensation  as  if  bound  tight  with  a  belt 
or  iron  band. 

(2)  Ataxic  stage. — The  first  sign  is  often  the  tumbling 
forward  into  the  basin  on  closing  the  eyes  during  washing 
in  the  morning,  another  is  the  difficulty  in  buttoning  up 
the  collar. 

The  patient  soon  feels  as  if  he  were  walking  on  wool 
instead  of  on  the  pavement,  and  cannot  turn  round  sud- 
denly, or  stand  with  his  eyes  shut.  He  has  to  look  at  his 
feet  when  he  walks.  He  is  no  weaker,  however.  Then  he 
may  have  vomiting,  acidity,  shortness  of  breath,  inability 
to  pass  his  urine  or  to  hold  it  sometimes.  The  skin  is 
dry;  the  nails  crack,  perhaps.  The  pupils  of  the  eyes 
are  small. 

(3)  Paralytic   stage. — The  patient  becomes  bed-ridden, 
and  sooner  or  later  dies  of  pneumonia  or  some  other  serious 
disease.     The  disease  is  probably  always  incurable,  but  some 
cases  caused  by  syphilis  have  recovered  under  treatment. 

Lumbago. — Rheumatic  pains  in  the  muscles  of  the  loins 
— backache.  This  often  comes  on  quite  suddenly  as  a 
violent  pain  in  the  back,  like  a  stab  with  a  dagger  in  the 
loin  muscles.  It  comes  on  again  every  time  the  sufferer 
rises  from  lying  down  to  the  erect  position,  and  also  some- 
times when  he  coughs  or  sneezes  or  laughs. 

He  is  apt  to  imagine  that  he  has  some  terrible  kidney 
disease  but  he  probably  has  not.  There  are  no  signs  of 
illness,  except  the  pain ;  and  it  is  not  like  the  pain  of  either 
kidney  or  liver  colic. 

When  it  is  better,  the  back  feels  stiff  and  sore  for  a 
long  time. 

Treatment. — As  in  the  treatment  of  all  other  pains,  we 
must  try  to  relieve  lumbago  not  only  by  local  applications, 
but  must  get  at  the  root  of  the  mischief  by  giving  medicine 
internally. 

Local  applications — 

(1)  Hot   fomentations,   sprinkled  with   laudanum   or 
turpentine. 

(2)  Put  a  piece  of  brown  paper  over  the  loins  and 
then  iron  them  with  a  heated  flat-iron. 

(3)  Hot-air  baths. 

(4)  "Baths"    of    warm    medicated    mud,    such    as 
"fango,"  are  very  useful  and  comforting. 


178  LUNGS,  DISEASES  OF  THE 

(5)  Rub  in  compound  camphor  liniment  four  times 
a  day,  and  let  the  patient  wear  a  warm,  wide,  woolen 
belt  next  his  skin,  around  the  loins  and  abdomen. 

(6)  Dry -cupping  of  the  loins  is  very  likely  to  give 
relief  to  lumbago  in  robust  and  full-blooded  persons. 
This  is  a  treatment  which  ought  to  be  done  by  a  doctor 
or  nurse,  but  as  there  are  always  a  few  people  who  like 
to  do  things  on  their  own  responsibility,  we  describe  the 
process  here.     To  dry-cup,  take  a  thick  glass  tumbler, 
and  put  into  it  a  bit  of  blotting-paper  sprinkled  with 
methylated  spirit.     Set  fire  to  the  paper,  and  just  before 
it  has  quite  burnt  out,  clap  the  mouth  of  the  glass  on 
to  the  loins  of  the  patient.     The  heating  of  the  air  in 
the  glass  has  "rarified"  it,  and  a  vacuum  is  produced  so 
that  the  skin  is  sucked  up  into  the  glass  and  the  blood 
rushes  to  it,  thus  being  drawn  from  the  seat  of  the  pain. 
The  glass  is  left  on  for  15  minutes.     This  can  be  re- 
peated in  several  places.     Wet-cupping  is  even  more  ef- 
fectual, but  it  cannot  be  done  by  non-medical  persons. 

(7)  If  the  patient  with  lumbago  wants  to  move  about, 
he  should   wear   a  plaster   made   from   equal  parts   of 
belladonna  plaster   and   opium   plaster   and   spread   on 
leather. 

(8)  Many   doctors   get   good   results   from   puncture. 
They  rapidly  insert  a  stout  needle  into  the  loins  and 
pull  it  out  again,  and  repeat  this  in  several  places.     It 
is  a  somewhat  painful  proceeding  at  the  time,  but  gives 
relief  directly  afterwards. 

(9)  It  may  be  necessary,  if  none  of  these  methods  give 
relief,  for  the  doctor  to  inject  some  medicine  into  the 
loin  with  a  syringe,  through  a  fine,  hollow  needle. 

(10)  Very  chronic  cases  of  lumbago  are  relieved  by 
blistering  freely. 

(11)  Electricity  is  used  in  some  hospitals  to  relieve 
pain.     Internal  remedies  are  such  as  these : — 

Aspirin,  sodium  salicylate  or  salicylate  of  colchicum. 

Lungs,  Diseases  of  the. — The  lungs  are  two  elastic  organs, 
occupying  the  chest  and  sharing  it  with  the  heart,  which  lies 
in  a  closed  membranous  bag  between  them.  The  chief 
duties  of  the  lungs  are: — to  enable  the  blood  which  cir- 
culates in  the  spongelike  tissue,  to  come  into  contact  with 
the  oxygen  of  the  air ;  and  to  give  off  carbonic  acid  gas  in 


MADNESS,  SYMPTOMS  OF  179 

the  breath.  The  oxygen  is  required  to  purify  the  blood 
which  gets  filled  with  carbonic  acid  gas  in  doing  its  work 
of  nourishing  the  tissues  of  the  body.  It  will  be  seen  that 
the  lungs  are  most  important  organs.  Thus: — 

(1)  If  they  are  undeveloped,  then  the  blood  does  not  get 
aerated  and  purified  as  well  as  it  should;  also  it  does  not 
give  up  its  carbonic  acid  gas  properly.     So  the  whole  nour- 
ishment of  the  body  suffers  and  the  body  remains  stunted. 

(2)  If  they   are  inflamed  or  diseased,   then  the  blood 
which  is  continually  circulating  through  them  carries  im- 
pure and  used-up  blood  to  the  rest  of  the  body,  instead 
of  pure  fresh  blood.     We  shall  refer  again  to  this  condition. 

(3)  If  the  lungs   are   too  much  developed — blown-out, 
as  in  many  athletes,  and  asthmatics  and  bronchitic  persons, 
and  glass-blowers,  and  wind-instrument  players,  then  they 
cannot  expand  and  contract  properly,  and  the  blood  never 
gets  properly  aerated.     The  results  are  shortness  of  breath, 
blueness  or  coldness  of  the  hands  and  feet,   and  so   on. 
(See  "Chest  Deformities.") 

(4)  In  people   who  suffer  from   Bright 's  disease,   and 
heart  disease,  the  lungs  are  apt  to  get  dropsical  or  * '  water- 
logged,"  and  hence  the  blood  cannot  be  properly  aerated. 

The  disease  which  is  most  important  of  all  those  which 
affect  the  lungs  themselves  is  one  known  as  "Pneumonia." 
This  is  also  called  "inflammation  of  the  lungs,"  but  as  it 
is  in  reality  a  disease  of  the  whole  body,  involving  the  whole 
of  the  respiratory  organs  and  the  digestive  and  other  or- 
gans as  well  (though  the  chief  mischief  is  in  the  lungs), 
we  shall  devote  a  separate  article  to  it.  (See  "Pneu- 
monia.") 

The  next  most  important  lung  disease  is  Broncho-Pneu- 
monia, in  which  there  is  Bronchitis  as  well  as  Pneumonia. 
It  is  commonest  in  children  under  five  years  of  age,  and  is 
very  often  fatal.  Other  lung  diseases  are  Abscess  of  the 
Lung,  Gangrene  of  the  Lung,  and  Tuberculous  Disease  of 
the  Lung,  which  is  another  name  for  our  old  enemy,  Con- 
sumption. Lastly,  the  lung  may  be  affected  with  Cancer. 

Madness,  Symptoms  of. — The  mental  symptoms  and  signs 
of  unsoundness  of  mind  are  mainly  three.  Every  insane 
person  has  one  or  more  of  these  symptoms,  though  it  is 
quite  possible  for  anybody  to  have  one  or  more  of  them 
in  a  very  slight  degree,  without  being  considered  or  treated 
as  insane.  A  very  large  number  of  persons  are  subject 


180  HALLUCINATION 

to  delusions;  and  as  long  as  they  are  harmless  delusions, 
and  as  long  as  the  patients  know  that  they  are  probably 
delusions,  and  do  not  act  upon  them,  there  is  no  need  to 
put  them  under  care  and  restraint  in  an  asylum  or  home. 
These  are  the  symptoms : — 

An  hallucination  is  a  disorder  of  one  of  the  special  senses 
(seeing,  hearing,  smelling,  tasting  or  feeling).  That  is  to 
say,  the  patient  fancies  that  he  hears  voices,  when  there 
are  really  no  voices ;  or  that  he  has  a  bad  taste  in  his  mouth, 
when  there  is  nothing  in  his  mouth  and  it  is  quite  healthy 
and  clean;  or  that  he  sees  persons,  who  are  not  there;  or 
that  he  smell  onions,  when  there  are  no  onions  near.  Cer- 
tain very  saintly  people  in  the  middle  ages,  particularly 
half-fed  and  badly-treated  nuns  and  monks,  used  to  fancy 
that  they  heard  voices — whether  from  heaven  or  hell — tell- 
ing them  to  do  certain  actions.  So  long  as  they  kept  com- 
mon sense  enough  not  to  act  upon  the  fancied  voices,  they 
were  sane;  but  as  soon  as  they  began  to  act  upon  the  sug- 
gestions (which,  after  all,  came  from  their  own  brains) 
then  they  were  really  insane.  Unfortunately,  no  one  in 
those  times  had  any  really  scientific  knowledge  about  in- 
sanity; and  the  result  was  that  if  these  poor,  half -starved 
creatures  acted  piously  as  the  result  of  the  "heavenly'' 
voices  which  they  thought  they  heard,  all  went  well  with 
them,  and  after  death  they  were  regarded  as  saints.  But 
if  the  voices  made  them  act  wrongly  and  commit  crimes 
instead,  they  were  said  to  be  "possessed  of  the  devil,"  and 
treated  accordingly.  Many  a  poor  wretch,  even  at  the 
present  day,  commits  crimes  at  the  instigation  of  "voices" 
which  do  not  exist  except  in  his  own  ears,  and  come  from 
his  poor  diseased  brain.  No  one  who  confesses  that  he 
hears  "voices"  talking  to  him,  or  about  him,  and  saying 
rude  or  slanderous  things  about  him,  is  quite  fit  to  be 
trusted;  at  any  time  he  or  she  may  become  quite  insane 
and  irresponsible.  The  golden  rule  in  all  such  cases  is  that 
of  securing  medical  advice  as  early  in  the  development  of 
the  ailment  as  may  be  possible.  This  practice,  in  fact,  con- 
stitutes the  only  hope  of  cure. 

An  illusion  is  a  false  perception  of  the  senses — that  is  to 
say,  the  senses  misinterpret  what  is  seen  or  heard.  A  per- 
son who  has  illusions,  for  example,  sees  an  empty  dressing- 
gown  hanging  behind  the  door  and  believes  it  to  be  a 
burglar  concealing  himself.  Some  persons  have  illusions 


MALARIA  181 

too,  but  they  do  not  act  upon  them,  or  at  any  rate,  act 
sensibly.  A  man  who,  seeing  his  beloved  wife  in  the  night 
standing  in  the  bedroom,  believes  her  to  be  the  devil,  and 
beats  the  life  out  with  a  poker  is  acting  insanely,  and  is 
certainly,  if  only  temporarily,  insane.  We  are  all  very 
often  obliged  to  doubt  the  evidence  of  our  senses ;  especially 
in  watching  conjuring  and  sleight-of-hand  tricks.  But  no 
sane  man  would  knock  a  conjurer  down  because  he  pounded 
up  his  gold  watch  before  his  eyes;  the  man  would  know 
quite  well  that  he  was  under  an  illusion  and  would  applaud 
the  cleverness  of  the  conjurer. 

The  third  mental  sign  of  insanity  is  delusion.  A  delu- 
sion is  a  disorder  of  consciousness.  It  is  a  false  belief  in 
some  fact  (which  nearly  always  concerns  the  patient  per- 
sonally) of  the  falsity  of  which  he  cannot  be  persuaded, 
either  by  his  own  senses,  knowledge  or  experience,  or  even 
by  the  declarations  of  others  whom  he  trusts.  A  man,  for 
instance,  may  believe  that  his  legs  are  made  of  glass,  and 
that  he  cannot  sit  down  without  a  risk  of  breaking  them. 
If  he  is  insane,  it  is  perfectly  hopeless  to  prove  to  him 
that  his  legs  are  flesh  and  blood  and  that  they  bleed  when 
pricked;  it  is  a  waste  of  time  to  argue  with  him.  He  is 
insane,  and  he  not  only  believes  that  his  legs  are  of  glass, 
but  he  is  terrified  lest  they  should  be  broken.  Of  course, 
he  is  not  always  quite  consistent  in  his  actions,  but  then 
none  of  us  are  quite  consistent,  even  when  we  are  sane. 
There  are  plenty  of  well-educated  people  who  are  under 
delusions  on  certain  subjects,  such  as  table-turning,  etc. 
These  are  "sane  delusions,"  or,  more  properly,  erroneous 
judgments.  A  perfectly  logical  and  consistent  sane  man 
would  argue,  if  invisible  spirits  could  be  got  to  rap  on 
tables,  and  make  them  turn  round  in  the  dark,  that  they 
might  fairly  be  expected  to  do  something  useful  and  serv- 
iceable also,  such  as  dusting  the  furniture  or  cooking  the 
dinner!  But  no  one  with  the  "table-rapping"  delusion 
ever  seems  to  expect  a  spirit  to  use  his  energy  in  a  reason- 
able and  useful  way ! 

Malaria. — This  is  the  general  term  for  diseases  that  have 
been  known  for  years  as  marsh-fever,  coast-fever,  ague,  jun- 
gle-fever. The  whole  subject  of  the  study  of  malarial  dis- 
eases forms  one  of  the  most  triumphant  and  interesting  of 
all  those  connected  with  the  science  of  medicine. 

Malaria  consists  of  a  series  of  periodical  attacks  of  fever 


182  MALARIA 

which  come  on  regularly  and  almost  exactly  just  when  they 
are  expected.  There  are  several  types.  Thus  you  may  get 
daily  malarial  fevers  (quotidian),  or  an  attack  every  other 
day  (tertian),  or  an  attack  every  third  day  (quartan). 

Cause. — The  cause  is  the  presence  in  the  blood  of  one  of 
three  parasites,  all  very  much  alike  and  microscopically  tiny. 
The  parasite  is  injected  into  the  blood  by  mosquitoes  which 
have  first  chanced  to  bite  someone  else  ill  with  malaria,  and 
have  themselves  become  infected.  It  is  believed  that  it  is 
impossible  to  catch  malaria  without  being  stung  by  a  cer- 
tain kind  of  mosquito,  called  the  anopheles.  The  parasites 
of  malaria,  thus  injected  into  the  body  by  an  infected 
mosquito,  multiply  rapidly  in  the  blood,  and  it  is  the  poison 
generated  by  their  presence  which  causes  the  feverish  at- 
tacks. 

Before  an  attack  of  malarial  fever,  or  ''ague  fit"  comes 
on,  the  patient  gets  headaches  and  shiverings,  but  he  may 
be  quite  well. 

The  ague  fit  itself  consists  of  about  an  hour  of  shivering 
(when  the  patient  gets  to  bed  and  piles  clothes  on  him- 
self, even  in  the  hottest  weather)  ;  then  several  hours  of  in- 
tense heat  and  high  fever  (when  he  throws  off  the  clothes 
and  vomits  and  has  violent  headache),  and  then  a  period  of 
sweating,  which  continues  till  he  has  gradually  recovered 
and  feels  quite  well.  The  whole  attack  happens  again  next 
day,  or  in  two  days,  or  in  three  days,  and  again  and  again, 
unless  he  is  properly  treated. 

Occasionally  persons  die  in  these  attacks. 

Now,  even  if  the  fever  is  neglected  (and  it  often  is), 
sooner  or  later,  if  the  person  leaves  the  malarious  country 
and  gets  no  more  mosquito  bites,  the  disease  wears  itself 
out  and  gives  no  more  trouble.  But  if  it  is  more  severe, 
malaria  becomes  a  chronic  disease  and  leads  to  a  chronic 
state  of  ill-health,  consisting  of  ancemia,  yellow  wasted  skin, 
enlarged  liver  and  enlarged  spleen.  This  is  called  by  doc- 
tors the  "malarial  cachexia." 

The  cure  of  malaria  is  accomplished  by  the  use  of  quinine, 
but  every  case  needs  special  care ;  and  the  same  form  or 
preparation  of  quinine  does  not  suit  everybody.  Moreover, 
no  two  people  thrive  on  exactly  the  same  dosage.  Overdoses 
of  quinine  upset  the  digestion  and  cause  giddiness  and  ring- 
ing in  the  ears. 

As  a  rule  five  grains  of  quinine  taken  three  times  a  day, 


MASSAGE  183 

in  capsule  or  pill  form,  is  sufficient  to  cure  an  acute  attack 
of  malaria  in  an  adult.  The  dosage  must  be  continued 
for  several  weeks,  however,  or  the  malarial  attack  may 
return. 

Prevention  of  Malaria. —  (See  also  "Mosquitoes.") — As 
the  only  method  by  which  malaria  can  be  contracted  is 
through  the  bite  of  a  mosquito  infected  with  malaria  the 
most  rational  way  to  prevent  it  is  by  destroying  all  mos- 
quitoes in  the  neighborhood  of  one's  residence.  Details  of 
the  methods  for  the  destruction  of  mosquitoes  are  given 
under  the  heading  "Mosquitoes." 

As  mosquitoes  can  only  obtain  the  malarial  parasite  from 
a  person  suffering  from  malaria  it  stands  to  reason  that 
the  best  way  is  to  keep  mosquitoes  away  from  the  malarial 
case  by  careful  screening. 

When  living  in  a  malarial  country  in  which  the  develop- 
ment of  mosquitoes  cannot  be  controlled,  some  protection 
may  be  secured  by  taking  quinine  from  time  to  time  in 
doses  of  ten  or  fifteen  grains  a  day. 

Malignant. — This  word  is  used  by  doctors  to  refer  to  any 
form  of  disease  which  is  more  serious  than  the  usual  type 
and  almost  certain  to  be  fatal.  Thus,  we  speak  of  malignant 
smallpox,  malignant  typhoid,  etc.  The  word  is  applied  also 
to  the  set  of  tumors  called  cancers,  which  include  every  form 
of  tumor  which,  if  left  alone,  will  ulcerate  and  kill  the 
patient  by  exhaustion,  and  which,  even  if  removed,  will 
probably  come  back  again,  growing  in  another  part  of  the 
body. 

Massage. — This  is  the  general  term  for  the  work  done  by 
nurses  who  are  skilled  and  certificated  masseurs,  or  mas- 
seuses (for  both  men  and  women  do  this  work) .  Their  Eng- 
lish name  is  "rubbers."  Massage,  or  scientific  medical 
rubbing,  can  be  learned  from  a  book,  by  those  who  know 
physiology;  but  no  masseur  is  of  any  use  until  he  under- 
stands the  meaning  of  the  rubbing  which  he  learns  to  do. 
The  movements  included  in  Massage  are  called  stabile  and 
labile.  The  stabile  movements  are  pressing,  pinching, 
hacking,  thrusting  and  tapping  the  skin  and  muscles,  to 
improve  the  circulation  and  stimulate  the  tissues.  The 
labile  movements  are  stroking,  rubbing  and  kneading. 
Massage  is  useful  in  the  following  complaints : — stiff  joints 
(unless  they  are  "strumous"  or  "tuberculous,"  when  they 
must  not  be  rubbed),  inflammatory  tough  thickening, 


184  MEASLES 

rheumatic  stiff  joints,  and  fractures,  or  broken  bones,  and 
a  few  cases  of  slight  paralysis  and  sprains. 

Measles. — A  majority  of  us  suffer  from  measles  in  child- 
hood. But  let  it  be  remarked  here  that  the  ideas  held  by 
many  of  the  ignorant  poor,  that  every  child  must  have 
measles,  and  that  a  child  therefore  might  as  well  be  put 
in  the  same  bed  with  a  brother  or  sister  who  has  the  dis- 
ease, are  absolutely  wrong,  if,  indeed,  not  criminal.  Dr. 
Alexander  Gordon  quotes  the  following  experience: — "A 
boy  of  14  had  measles,  and  his  mother,  feeling  sure  that 
the  other  children  would  catch  the  disease  in  any  case, 
took  no  precautions.  Her  six-months  old  baby  died  after 
two  days  of  measles,  and  her  little  girl  of  two  years  lost 
the  sight  of  both  eyes.  So  much  for  the  wickedness  of  the 
superstition. ' ' 

The  disease  is  contagious,  and  infects  the  air  round  the 
patient  and  the  clothes  which  he  wears,  though  to  a  less 
degree  than  scarlet  fever  does.  It  is  even  more  contagious 
before  the  rash  comes  out  than  afterwards.  Between  the 
day  of  catching  the  disease  and  the  first  signs  of  it,  about 
ten  days  elapse.  It  begins  with  feverishness,  loss  of  appe- 
tite, drowsiness,  and  chills,  and  in  some  children  with 
vomiting  or  fits.  Then  the  eyes  get  red  and  watery,  the 
nose  runs,  and  there  is  a  cough  because  the  air-tubes  in 
the  lungs  are  also  affected.  On  the  fourth  day  of  this 
"bad  cold"  the  rash  comes  out.  (See  "Rashes  on  the 
Skin.")  There  are  pink  spots,  round,  and  afterwards  ir- 
regular in  shape,  patches  of  redness  with  scalloped  edges. 
Only  a  doctor  can  distinguish  between  it  and  the  rash  of 
scarlet  fever.  The  rash  is  mostly  on  the  face  which  gets 
red  and  blotchy,  but  there  are  some  patches  on  the  body 
and  limbs,  too.  In  three  days  it  has  reached  its  height  and 
then  it  begins  to  fade,  leaving  mottled,  brownish  patches 
from  which  the  skin  is  shed  in  tiny  bran-like  fragments. 
This  "peeling"  is  often  hardly  noticeable.  The  feverish- 
ness  is  worse  when  the  rash  breaks  out,  and  then  begins  to 
subside.  After  about  a  week  the  patient  begins  to  get  well 
again. 

This  is  an  ordinary  mild  case  of  measles  without  compli- 
cations. But  there  are  many  possible  complications. 
Thus,  the  catarrh  of  the  air-tubes  may  become  a  real  severe 
bronchitis,  or  the  lung  itself  may  share  the  inflammation 
which  then  develops  into  a  pneumonia.  Then  the  voice- 


MEASLES  185 

box  or  larynx  may  become  inflamed  too,  and  laryngitis 
comes  on,  with  a  croupy  cough  and  hoarseness.  Other  com- 
plications are,  inflammation  of  the  eyes  (ophthalmia),  of 
the  mouth,  of  the  bowels  (causing  diarrhea),  and  of  the 
ears.  Enlarged  tonsils,  swollen  glands  and  tuberculosis 
and  pleurisy  are  all  apt  to  occur. 

Treatment. — When  a  child  is  1 1  sickening "  in  the  way 
above  described,  the  disease  may  turn  out  to  be  measles, 
or  German  measles,  or  scarlet  fever.  It  is  wise  to  have  the 
child  under  medical  supervision  from  the  first — in  order 
to  name  the  disease  correctly,  to  treat  it  correctly,  and  to 
guard  against  complications. 

No  one  can  possibly  cut  short  or  ''cure"  the  disease  all 
at  once.  But  a  good  doctor  can  point  out  how  best  to 
guide  and  support  the  patient  until  the  course  of  the  dis- 
ease is  run,  and  how  so  avoid  the  terrible  possible  complica- 
tions. Briefly,  this  is  what  to  do — (1)  Isolate  the  child  if 
possible  in  a  room  with  not  a  single  piece  of  unnecessary 
furniture.  (2)  Let  the  temperature  of  the  sick-room  be 
not  less  than  60°  and  not  more  than  70°.  (3)  Moisten 
the  air  by  boiling  a  kettle  in  the  room  and  have  plenty  of 
steam.  It  helps  the  patient  to  breathe.  (4)  Have  two 
beds  in  the  room,  one  for  day  and  one  for  night.  Ventilate 
it  well  with  open  window  or  door,  using  screens  round  the 
bed  itself.  Plenty  of  fresh  air,  but  no  draughts.  (5) 
Have  a  subdued  light  in  the  room.  (6)  Disinfect  freely. 
Use  a  good  disinfectant,  and  be  sure  to  put  some  of  it  into 
the  bed-pan  before  and  after  use,  and  to  rinse  all  vessels 
in  it  which  have  been  used  by  the  patient.  (7)  Milk  diet 
is  necessary,  milk  alone,  or  with  lime  water  or  soda  water. 
Barley-water  and  lemon  juice  or  home-made  lemonade  may 
be  freely  given.  (8)  If  the  fever  is  high  the  doctor  may 
direct  you  to  sponge  the  body  with  tepid  water.  The  cough 
in  ordinary  cases  needs  no  special  medicine.  (9)  To  ease 
the  feverishness  at  first,  you  may  give  a  teaspoonful  of  this 
mixture  to  any  child  with  measles  from  2  to  5  years  of 
age: — Solution  of  acetate  of  ammonia,  2  ounces;  spirit  of 
nitrous  ether,  2  drachms;  sirup,  1  ounce;  distilled  water 
to  4  ounces:  mix.  Dose — One  teaspoonful  every  two  or 
three  hours.  (10)  After  a  week,  in  ordinary  cases  the 
child  may  get  up  from  bed  but  not  leave  the  room.  In  the 
poorer  classes  children  are  generally  allowed  out  too  soon; 
hundreds  of  cases  of  consumption  and  deafness  and  chest 


186  MEDICINE  CHEST 

troubles  are  due  to  this  serious  mistake.  In  the  winter  no 
child  ought  to  be  allowed  to  run  about  in  the  open-air  for 
at  least  a  month  after  the  attack.  "Serious  complications 
are  more  common  after  measles  than  after  any  other  dis- 
ease/' wrote  Dr.  Whitla.  (11)  During  convalescence 
tonics  will  be  wanted,  such  as  quinine  and  iron,  to  improve 
the  appetite.  Whooping  cough  is  very  common  after 
measles.  No  case  of  either  of  these  diseases  should  be 
treated  without  medical  advice. 

Medicine  Chest. — Here  follow  a  few  suggestions  for  the 
home  medicine-chest.  Bottles  ought  to  be  labeled  with 
large  white  labels,  well  written,  and  perfectly  clear. 
Poisons  must  have  red  as  well  as  white  labels,  and  they 
ought  to  be  in  green  or  blue  fluted  bottles,  so  that  they  can 
be  picked  out  when  the  light  is  bad.  On  every  bottle 
there  ought  to  be  written  the  dose  of  the  medicine,  and,  in 
case  of  poisons,  their  uses. 

A  well-stocked  home  medicine  chest  should  contain: — 

A  pair  of  scales  and  drachm  and  grain  weights. 

A  clinical  thermometer  (see  notes  below). 

A  glass  measure,  marked  in  drachms  and  ounces. 

A  minim  measure,  for  small  doses. 

A  medicine  glass,  marked  in  teaspoonfuls  and  table- 
spoonfuls. 

A  feeding-cup. 

A  glass  eye-bath. 

Brushes  for  painting  out  the  throat  (no  two  persons 
to  use  the  same  brush). 

A  piece  of  oiled  silk,  say  a  square  yard,  or  a  piece  of 
jaconet. 

A  roll  of  surgeon's  lint. 

A  bottle  of  pastils  (or  tabloids  or  soloids)  of  corrosive 
sublimate,  for  making  lotions,  for  washing  ulcers, 
etc. 

A  cake  of  carbolic  soap,  10  per  cent. 

A  waterproof  sheet,  for  confinements,  etc. 

A  roll  of  adhesive  plaster. 

A  glass  ear-syringe:  A  Higginson  syringe. 

A  bottle  of  household  ammonia,  for  bites  of  insects, 
stings,  etc. 

Bandages,  assorted.  A  "wringer"  (see  "Fomenta- 
tions," pp.  86-7). 


MEDICINE  CHEST  187 

For  external  application,  in  bottles  marked  POISON  : — 

Liniment  of  iodine,  two  ounces  (see  notes  below). 

Glycerin  of  the  subacetate  of  lead,  four  ounces. 

Creosote,  pure,  two  drachms. 

Zinc  sulphate,  four  ounces  (see  notes). 

Carbolic  acid  lotion,  1  in  60,  two  pints. 

Friar's  balsam,  four  ounces. 

A  bottle  of  smelling  salts. 

Boric  acid  powder,  one  ounce. 

Zinc  ointment  (one  ounce). 

Sulphur  ointment  (for  the  itch). 

Hamamelis  ointment  (for  piles). 

For  internal  use — (1)  as  purgatives:— 

Sirup  of  senna,  two  ounces.     (Dose  for  children,  one 

drachm. ) 
Epsom  salts,  half-a-pound.  (Dose  30  grains  to  half- 

ounce.) 

Compound  rhubarb  pills,  four  grains  in  each. 
Calomel,  a  bottle  of  tablets  of  a  grain  each. 
Castor  oil,  four  ounces.     (Dose,  about  one  ounce.) 

(2)  To  relieve  pain: — 

Laudanum,    half   a    fluid    ounce.     (Dose,    up    to    30 

minims. ) 
Paregoric,  two  ounces.  (Dose  half  to  one  drachm 

[adult].) 
Phenacetin  and  caffeine  tablets,  25. 

(3)  To  stop  bleeding:— 

Alum  powder,  two  ounces  (see  also  notes  below). 

(4)  To  stop  diarrhea:— 

Aromatic    chalk    powder.     (Dose    10    grains    to    one 

drachm. ) 

Salol  (five  grain  tablets),  25. 
Gray  powder    (for  children),    an   ounce.     (Dose,    % 

grain. ) 

(5)  For  coughs,  etc.: — 

Ipecacuanha  wine,  two  ounces.     (Dose,  10  to  30  min- 
ims.) 

Sal  volatile,  two  ounces.     (Dose,  one  drachm  in  water.) 
Pil.  Ipecac,  et  Scillae. 


188  MEDICINES 

(6)  For  feverish  colds: — 

Quinine  tablets  of  two  grains  each,  25. 
Dover's  powder  tablets,  five  grains  in  each,  25. 
Smelling  salts. 

NOTES  ON  THE  FOREGOING  MEDICINES,  ETC.  : — 

A  clinical  thermometer  is  marked  from  95°  to  107° 
Fahrenheit.  It  is  used  by  placing  the  mercury  bulb  under 
the  tongue,  closing  the  mouth,  and  leaving  the  thermometer 
there  for  three  minutes  or  less,  according  to  the  make  of 
the  thermometer.  A  person  in  health  varies  from  96°  to 
98.4°.  Above  99°  he  is  said  to  be  feverish,  and  below  96° 
he  is  said  to  be  subnormal,  and  may  be  in  " collapse." 
Some  people  prefer  to  "take  the  temperature"  in  the  arm- 
pit, which  must  be  wiped  dry  before  the  bulb  of  the  ther- 
mometer is  put  there,  and  it  must  be  left  there  about  15 
minutes.  After  use,  the  mercury  column  is  to  be  taken 
down  again  by  jerking. 

The  throat-brush  must,  of  course,  be  used  for  nothing 
else,  and  thoroughly  washed  every  time.  Each  brush 
should  have  a  label  gummed  onto  it,  bearing  the  name  of 
the  person  who  has  used  it.  The  brush  must  be  dipped  into 
the  glycerin  of  tannic  acid  (used  for  painting  the  throat) 
in  a  saucer  and  not  in  the  bottle. 

Corrosive  sublimate  lotions. — One  part  in  2,000  of  water 
is  a  strong  enough  antiseptic  lotion  for  most  purposes. 

Carbolic  soap. — The  hands  ought  to  be  washed  with  this 
before  any  cuts,  ulcers,  or  burns  are  attended  to. 

Bandages. — A  three-inch  unbleached  calico  bandage  can 
be  cut  into  two  in  its  new  rolled-up  condition,  by  a  sharp 
knife,  if  finger  bandages  are  wanted. 

Liniment  of  iodine  is  good  for  painting  on  chilblains,  and 
for  painting  on  the  skin  of  the  whole  of  the  chest,  back  and 
front,  in  cases  of  irritable  and  frequent  cough. 

Subacetate  of  Lead  with  glycerin  is  useful  in  eczemas, 
especially  if  mixed  with  four  parts  of  fresh  milk  and  ap- 
plied on  lint.  Goulard  water  is  the  name  given  to  the 
diluted  solution  of  subacetate  of  lead,  and  it  is  used  as  a 
lotion  for  sprains  and  bruises.  Mixed  with  one-eighth  of 
its  volume  of  laudanum,  it  becomes  "lead  and  opium  lo- 
tion," and  is  useful  for  painful  bruises  and  itchiness  of  the 
skin. 


CASTOR  OIL  189 

Creosote  is  useful  in  toothache.  One  drop  on  a  tiny  piece 
of  cotton-wool,  put  into  a  hollow  aching  tooth  will  relieve 
the  pain.  Oil  of  cloves  would  do  as  well.  Two  to  five 
drops  swallowed  in  a  bread  pill  will  often  stop  seasickness. 

Zinc  sulphate. — Externally,  this  is  very  useful.  Ked  lo- 
tion, used  for  ulcers  (see  "Ulcers")  is  made  of  zinc  sul- 
phate, 20  grains;  compound  tincture  of  lavender,  150 
minims;  and  water  to  half-a-pint.  As  an  eye  lotion  for 
inflamed  eyes,  use  30  grains  to  10  ounces  of  pure  water. 
But  zinc  sulphate  is  an  internal  medicine  also.  Taken 
internally  in  doses  of  from  one  to  three  grains  (for  an 
adult)  it  is  a  good  tonic,  and  in  doses  of  from  10  to  30 
grains  it  acts  as  an  emetic  and  produces  vomiting.  It  is 
useful  to  have  this  drug,  therefore,  always  in  the  house. 

Friar's  balsam  (compound  tincture  of  benzoin). — This  is 
one  of  the  most  useful  things  in  the  chest.  Externally  it 
is  an  excellent  antiseptic  soothing  and  healing  application 
for  all  cuts  and  wounds.  A  cut  finger  may  be  wrapped 
round  with  a  bit  of  clean  lint  dipped  in  balsam,  and  covered 
with  a  piece  of  jaconet,  and  the  dressing  need  not  be  re- 
moved until  the  cut  is  healed.  Of  course,  before  applying 
the  balsam  you  must  hold  the  cut  under  the  tap  for  a  time 
to  get  the  wound  quite  clean. 

Internally,  a  good  cough  mixture  may  be  made  for  a 
hard,  painful  cough  by  putting  an  ounce  of  balsam  into  an 
eight-ounce  bottle  and  filling  up  with  water.  Dose,  a  table- 
spoonful  three  or  four  times  a  day.  Again,  a  teaspoonful 
of  the  balsam  in  a  jug  of  boiling  water  gives  off  a  healing 
vapor  very  useful  in  hoarseness  and  sore  throat. 

Boric  acid  powder,  a  clean,  non-irritating  antiseptic  dust- 
ing powder  for  all  sorts  of  purposes. 

Compound  rhubarb  pills  are  to  be  taken,  say,  one  every 
evening,  by  persons  with  costive  bowels  and  furred  tongue. 

Calomel  is  a  splendid  liver  stimulant.  Bilious  people, 
who  suffer  from  specks  before  the  eyes  and  headaches, 
should  take  a  dose  of  calomel  in  the  evening,  occasionally, 
and  follow  it  up  by  a  dose  of  Epsom  salts  next  morning. 
Calomel  powder  should  be  dusted  on  those  ulcers  on  the 
lower  third  of  the  leg  occasionally,  and  on  those  mucous 
red  patches  on  the  face,  and  on  the  privates  of  persons  with 
syphilis. 

Castor  oil. — Besides  being  a  purgative  it  is  useful  for  the 
eyes.  One  drop  of  castor  oil  when  you  have  "grit  in  the 


190  MEDICINES 

eye"  gives  almost  instant  relief.  Every  case  of  summer 
diarrhea  ought  to  be  given  a  dose  of  castor  oil  first,  to  clear 
the  bowels  out. 

Laudanum  is  tincture  of  opium  and  poisonous.  It  is  use- 
ful in  all  cases  of  mysterious  colic  or  pain  of  any  kind  if 
the  doctor  cannot  be  had.  It  is  useful  as  a  local  applica- 
tion, too,  especially  for  toothache,  or  to  increase  the  action 
of  poultices. 

Paregoric  is  compound  tincture  of  camphor.  It  is  useful 
for  children's  coughs  and  restlessness  and  sleeplessness, 
especially  when  combined  with  ipecacuanha  wine. 

Phenacetin  with  caffeine  is  very  useful  for  migraine  or 
sick  headache  due  to  fatigue  or  too  much  reading;  also  for 
feverish  attacks. 

Alum  is  an  astringent,  and  useful  for  gargles  in  cases  of 
relaxed  sore  throat,  especially  if  combined  with  an  equal 
quantity  of  chlorate  of  potash.  A  teaspoonful  of  each  to 
half-a-pint  of  water  will  make  a  strong  gargle. 

Alum  will  also  stop  bleeding  from  razor  cuts.  All  bar- 
bers keep  blocks  of  it  on  their  shelves.  A  teaspoonful  of 
alum  in  a  very  little  water  will  often  act  as  an  emetic. 
With  four  grains  to  the  ounce  of  water  may  be  made  an 
eye  lotion  for  bloodshot  eyes.  A  lotion  of  twice  that 
strength,  as  a  vaginal  douche,  is  useful  for  women  who 
suffer  from  ' '  whites. ' ' 

Salol  will  not  stop  diarrhea  of  itself ;  but  it  disinfects  the 
bowels  and  thus  removes  the  irritating  matters  which  are 
causing  the  diarrhea. 

Ipecacuanha  wine  is  an  emetic  in  doses  of  four  to  six 
drachms,  but  in  doses  of  10  to  30  drops  (adult)  it  is  a 
splendid  expectorant,  and  makes  a  cough  easier. 

Quinine  as  well  as  phenacetin  is  "good  for"  feverishness, 
but  it  is  no  use  trying  to  knock  down  fever  until  the  bowels 
are  acting  freely. 

Dover's  powder  (compound  ipecacuanha  powder,  con- 
taining also  opium).  It  increases  the  action  of  the  skin, 
causing  a  healthy  free  perspiration  in  acute  catarrhs;  and 
it  checks  diarrhea.  For  children  it  is  almost  the  only  safe 
preparation  of  opium ;  the  dose  is  one  grain  for  every  year 
of  the  child 's  life. 

Gray  powder. — This  is  mercury  with  chalk.  It  is  of  the 
utmost  use  for  children  with  diarrhea  in  doses  of  half-a- 
grain,  twice  a  day,  especially  for  those  puny,  miserable 


MENSTRUATION  191 

children  who  are  of  unhealthy  parents  and  badly  fed,  and 
are  always  having  diarrhea  with  foul  fetid  motions. 

Meningitis. — This  disease  may  be  of  tubercular  origin, 
occurring  as  a  primary  disease  in  children  or  in  adults 
secondary  to  tubercular  infection  elsewhere  in  the  body. 

Epidemic  Cerebro-spinal  Meningitis  is  an  acute  germ 
disease  caused  by  the  meningocoecus,  occurring  most  fre- 
quently in  the  young,  but  not  confined  to  any  age.  The 
disease  usually  begins  abruptly  with  a  chill  followed  by 
vomiting,  excruciating  pain  in  the  head,  back  and  limbs. 
The  head  is  bent  back. 

There  is  high  fever  and  sensitiveness  to  light,  sound  and 
touch. 

Untreated  or  improperly  treated,  this  disease  usually 
results  in  death;  or  if  recovery  takes  place  is  very  liable 
to  be  followed  by  blindness,  deafness,  paralysis  or  imbecility. 

A  physician  should  be  called  at  the  earliest  possible  mo- 
ment, for  if  antimeningococcus  serum  can  be  administered 
early  enough  complete  recovery  takes  place  in  the  great 
majority  of  cases. 

Prevention. — All  cases  should  be  promptly  isolated.  As 
most  cases  occur  in  the  presence  of  unhygienic  conditions, 
care  should  be  taken  to  improve  the  sanitary  conditions 
where  danger  of  infection  threatens. 

As  infection  is  probably  contracted  through  the  mucous 
membranes  of  the  nose  and  mouth  the  hygiene  of  these 
cavities  should  be  carefully  seen  to  by  the  use  several  times 
a  day  of  a  mild  antiseptic  solution  such  as  the  official  Liquor 
Antisepticus  Alkalinus. 

For  this  purpose  a  nasal  douche,  such  as  may  be  had  at 
any  drug  store,  is  of  service. 

Menstruation. — This  is  a  natural  function  in  every  fe- 
male. The  discharge,  which  occurs  about  every  twenty- 
eight  days  and  lasts  from  three  to  eight  days,  is  accom- 
panied, in  many  women,  by  feelings  of  tiredness,  headache 
and  irritability ;  and  in  some  cases  by  severe  pain  and  sick- 
ness. In  a  few  women  the  whole  phenomenon  is  painless 
and  gives  no  trouble  at  all.  This  function  of  menstruation 
begins,  in  temperate  climates,  between  the  ages  of  14  and 
16,  and  as  soon  as  it  has  become  established  the  girl  is  said 
to  have  reached  the  ' '  age  of  puberty. ' ' 

During  pregnancy  the  process  does  not  occur,  and  in 
fact  the  sudden  cessation  of  the  flow  is  often  the  first  sign 


192  MIDDLE-AGE 

that  a  woman  is  about  to  bear  a  child.  While  suckling  her 
baby,  the  flow  is  still  suspended,  and,  among  the  poor, 
women  often  continue  to  suckle  a  child  far  beyond  the 
proper  length  of  time  (about  six  months)  because  they 
wrongly  suppose  that  a  new  pregnancy  is  impossible  as 
long  as  suckling  is  continued. 

Disorders  of  Menstruation. —  (1)  It  occasionally  happens 
that  menstruation  ceases  in  a  woman  who  is  neither  married 
nor  about  to  be  a  mother.  This  should  not,  in  itself,  cause 
alarm.  The  reason  is  probably  that  she  is  anaemic,  or  poor- 
blooded,  and  that  Nature  is  trying  to  set  matters  right  in 
her  own  way.  At  the  same  time,  the  doctor  ou^ht  to  be 
consulted. 

(2)  In   some   women  menstruation   is   accompanied   by 
much  pain,  headache,  backache  and  languid  feelings.     This 
may  be  due  to  neuralgia,  inflammation,  or  some  other  cause. 
For  a  woman  who  has  never  borne  children  or  suffered  from 
any  internal  complaint  requiring  a  medical  examination, 
the  following  medicine  will  be  found  useful : — antipyrin, 
30  grains;  tincture  of  castoreum,  90  minims;  liquor  mor- 
phine, 20  minims;  spirit  of  chloroform,  40  minims;  water 
to  6  ounces.     A  fourth  part  to  be  taken  every  two  hours 
while  the  pain  continues,  but  not  more  than  four  doses  are 
to  be  taken  altogether,  except  by  express  medical  advice, 
because  this  medicine  contains  poison.     Very  often  these 
cases  are  benefited  by  surgical  treatment  in  a  hospital. 

(3)  In  the  few  cases  in  which  very  large  quantities  of 
blood  are  lost  at  each  period,  no  home  treatment  ought  to 
be  attempted,  but  medical  advice  obtained  before  severe 
anaemia  sets  in.     (See  also  "Change  of  Life/') 

Middle-aged  Man,  The. — "  After  the  age  of  50,  the  less  a 
man  eats  and  drinks,  the  more  healthy  he  is  likely  to  be." 
Let  us  see  how  and  why  this  statement  is  true.  In  the 
first  place  we  all,  or  nearly  all,  eat  a  good  deal  more  than 
we  need.  We  could  almost  certainly  do  all  the  work  re- 
quired of  us  on  a  very  much  smaller  consumption  of  food, 
and  we  could  generally  do  it  better  without  stimulants, 
such  as  spirits.  Now,  of  course,  all  food  contains  only 
a  certain  amount  of  nourishment;  the  remainder  of  it  is 
waste  matter,  and  has  to  be  got  rid  of  somehow,  by  kidneys, 
and  bowels,  and  skin,  and  breath.  These  are  facts  of  very 
elementary  physiology,  such  as  every  child  ought  to  be 


MIDDLE-AGE  193 

taught  at  school;  but,  unfortunately,  the  majority  are  still 
ignorant  of  them,  and  thoughtless  about  them. 

While  one  is  still  young,  the  body  will  answer  to  almost 
any  strain  that  is  put  upon  it,  for  a  time ;  and  that  is  how 
it  is  that  excesses  and  unsuitable  foods  do  not  hurt  as  much 
as  might  be  expected.  If  one  eats  too  much  meat,  or  drinks 
too  much  of  that  very  unnecessary  alcohol,  the  youthful 
body  strains  a  few  points  and  gets  over  the  trouble  by 
drawing  on  the  reserve  powers.  In  middle-age  there  is 
less  reserve  power,  and,  especially  in  those  who  have  been 
careless  or  dissipated  in  youth,  the  body  finds  it  difficult  or 
impossible  to  get  rid  of  the  waste  matters  in  the  food. 

Again,  in  middle-age  we  are  too  ready  to  take  less  exer- 
cise, to  ride  instead  of  walk,  and,  worst  of  all,  to  find  our 
chief  pleasure  in  eating  and  drinking.  We  are  apt  to  get 
stout,  and,  as  we  grow  more  and  more  self-indulgent,  we 
get  fatter  still.  This  is  so  common  that  it  is,  unfortu- 
nately, looked  upon  as  quite  "natural"  to  get  fat  in  middle- 
age.  The  French  have  a  proverb  which  means,  '  *  To  get  fat 
is  to  grow  old,"  and  it  is  often  true.  But  the  getting  fat 
is  not  the  worst  thing  that  may  happen;  and,  as  a  fact, 
many  people  admire  fleshiness  in  middle-aged  people.  The 
storage  of  waste  matters,  due  to  eating  too  much,  in  middle- 
age — especially  the  eating  of  much  animal  food,  and  the 
drinking  of  sweetened  alcoholic  drinks — leads  to  about  half 
the  headaches,  backaches,  rheumatics,  and  gout  of  the 
middle-aged. 

By  the  time  one  reaches  middle-age  one  ought  to  have 
stored  up  a  supply  of  energy  enough  to  carry  one  on 
through  life.  After  50,  the  only  food  taken  ought  to  be 
just  enough  to  keep  one  going,  and  not  so  much  as  to  leave 
waste  matters  in  the  system,  to  produce  headaches,  and 
rheumatism,  and  gout.  Much  meat  and  alcohol  are  the 
two  chief  offenders.  The  middle-aged  man  or  woman  can- 
not only  do  well  with  very  little  of  them,  but  will  actually 
enjoy  life  better  in  every  way  with  as  little  as  possible  of 
them.  He  will  have  a  clearer  mind  and  more  active  body 
if  he  takes  only  what  he  requires  to  keep  up  a  fair  weight. 
Let  those  of  our  middle-aged  readers  who  have  tried  this 
plan  bear  witness  to  our  truthfulness. 

In  conclusion,  we  warmly  recommend  all  middle-aged 
people,  married  or  single,  male  or  female,  to  read  the  valu- 


194  MILK 

able  book  by  Sir  Henry  Thompson,  entitled,  Diet  in  Rela- 
tion to  Age  and  Activity. 

Milk, — Of  any  one  factor  in  the  maintenance  of  the  health 
of  a  family,  the  milk  supply  is  without  doubt  the  most 
important.  It  may  be  very  good  and  an  important  fac- 
tor in  the  growth  of  a  healthy  family.  It  may  be  very  poor 
and  responsible  for  much  disease  and  ill-health. 

Cow's  milk,  containing  all  elements  of  nutrition,  is  an 
ideal  food.  It  is  therefore  destined  to  be  almost  univer- 
sally consumed  in  vast  quantities  by  man  whatever  his 
environment  or  mode  of  living.  But  unfortunately  milk 
is  also  an  unusually  favorable  soil  for  the  growth  of  bac- 
teria, the  pathogenic  varieties  of  which  are  man's  most 
insidious  enemies,  to  be  feared  and  fought  as  were  the  wild 
beasts  of  the  forest  by  our  primeval  ancestors. 

In  the  various  processes  of  handling  and  transportation 
which  milk  for  city  supply  undergoes  between  its  produc- 
tion and  consumption  there  lurks  the  danger  of  contamina- 
tion at  every  step,  even  assuming  that  the  milk  was  free 
from  disease  germs  when  drawn  from  the  cow.  Great  as 
is  the  danger  under  ordinary  conditions,  it  has  been  enor- 
mously increased  by  the  progressive  lengthening  of  the 
time  that  elapses  between  production  and  consumption. 

As  our  modern  cities  grew,  the  source  of  milk  supply, 
as  of  all  food  supply,  was  pushed  out  into  wider  and  wider 
encircling  areas  until  now  the  inhabitants  of  a  large  urban 
community  must  frequently  wait  a  day  and  a  half,  or  two 
days  after  the  milk  is  produced  before  it  reaches  their 
tables.  For  it  must  be  realized  that  the  2,000,000  quarts  of 
milk  which  New  York  City,  for  example,  consumes  a  day, 
comes  from  44,000  farms  situated  in  seven  different  States, 
and  some  of  this  milk  travels  400  miles  before  it  reaches 
the  consumer. 

The  commoner  diseases  which  may  be  transmitted  by 
milk  are  typhoid  and  scarlet  fever,  tuberculosis,  diphtheria 
and  summer  diarrhea. 

The  methods  of  avoiding  diseases  transmitted  in  this 
way  are  by  cleanliness  and  precautions  at  the  dairy  to  pre- 
vent the  milk  being  contaminated;  and  destruction  of  the 
germs  in  the  milk  a  short  time  before  it  is  consumed. 

If  a  choice  can  be  exercised  in  the  source  of  a  milk  sup- 
ply, procure  milk  from  a  dairy  which  is  inspected  properly 
and  kept  in  a  sanitary  condition.  Milk  should  only  be  used 


MILK  195 

from  cow's  proved  to  be  free  from  tuberculosis  by  the 
tuberculin  test.  Of  milk  from  dairy  supplies  not  so  con- 
trolled 10  per  cent,  is  found  to  contain  tubercle  bacilli  and 
can  produce  tuberculosis  in  children. 

Milk  should  be  kept  cooled  from  the  time  it  is  produced 
until  it  is  consumed,  except  during  the  few  minutes  when 
it  is  being  pasteurized.  This  is  one  of  the  most  important 
factors  in  preventing  the  growth  of  bacteria.  Milk  which 
has  been  collected  and  handled  under  the  best  conditions 
may  have  only  5,000  bacteria  per  cubic  centimeter  when 
sold. 

A  bacterial  count  of  10,000  per  cubic  centimeter  is  very 
good  for  bottled  milk — the  average  being  from  10,000  to 
100,000.  The  bacterial  count  for  milk  in  cans  runs  from 
100,000  to  40,000,000  per  cubic  centimeter. 

The  advantage  of  using  bottled  milk  is  therefore  seen  at 
a  glance. 

When  so  many  bacteria  constantly  occur  in  milk,  and  as 
the  danger  is  so  great  that  among  these  numerous  bacteria 
some  will  be  disease-producing  ones,  the  only  way  to  make 
milk  safe  to  drink  is  by  pasteurizing  it.  Many  large  deal- 
ers are  now  doing  this  by  exposing  milk  in  bulk  to  a  tem- 
perature of  140°  F.  for  twenty  minutes  and  bottling  it 
immediately  in  sterile  bottles.  All  milk  not  thus  treated 
should  be  pasteurized  at  home.  This  can  be  done  conven- 
iently by  the  use  of  the  Freeman  pasteurizer — by  which 
milk  is  maintained  at  a  temperature  of  75°  C.  for  30  min- 
utes. This  does  not  render  the  milk  absolutely  sterile  or 
kill  all  the  spores,  but  it  kills  practically  all  the  disease 
germs  and  is  sufficiently  effective  to  check  fermentation. 

Pasteurized  milk  should  not  be  kept  more  than  24  hours. 

In  the  home  milk  should  constantly  be  kept  cool  and  in 
sealed  bottles  to  prevent  the  access  of  flies — a  most  danger- 
ous source  of  contamination. 

Shun  as  you  would  poison  milk  which  has  been  obtained 
in  small  quantities  from  a  can  in  a  dirty  retail  grocery 
store  where  little  or  no  attempt  has  been  made  to  keep  the 
milk  iced  or  to  prevent  the  access  of  flies. 

Milk,  Artificial  Human.—  (See  also  "Infant  Feeding.")— 
Every  child  ought  to  be  breast-fed  for  the  first  six  or  eight 
months  of  its  life.  For  the  first  three  days  the  milk  is  not 
very  good,  but  the  child  ought  to  be  put  to  the  breast  both 
because  that  stimulates  the  breast  into  action  and  because 


196  MIND  FAILURE 

the  milk  purges  the  child  a  little.  No  other  food  is  neces- 
sary or  ought  to  be  given.  When  the  flow  of  milk  is  well 
set  up  the  baby  ought  to  be  put  to  the  breast  at  regular 
intervals  of  from  two  to  three  hours  during  the  day,  for 
ten  minutes  at  a  time,  and  less  frequently  during  the  night. 
No  crying  on  baby 's  part  ought  to  make  a  difference  in  this. 
But  if  the  mother  cannot  suckle,  the  child  must  have  a  wet- 
nurse,  or  artificial  food.  The  milk  of  mares  and  asses  most 
nearly  resemble  the  milk  of  women.  Cow's  milk  pure 
needs  the  addition  of  water,  cream  and  sugar  to  make  it 
anything  like  human  milk  in  digestibility. 

The  shape  and  make  of  baby's  bottle  are  important.  Two 
bottles  ought  to  be  in  use,  and  the  one  not  in  use  ought  to 
be  lying  in  concentrated  boric  acid  solution,  to  "sterilize" 
it  free  from  all  germs.  The  boat-shaped  bottles  are  the 
best;  there  must  be  no  india  rubber  tube.  The  Ballin 
baby's  bottle  is  to  be  warmly  recommended.  It  can  be 
obtained  through  any  chemist. 

Even  if  there  is  no  epidemic  of  any  sort  about,  milk, 
even  if  obtained  with  the  greatest  precautions,  may  con- 
tain some  disease  germs  such  as  the  typhoid  or  diphtheria 
bacilli,  the  germs  of  tuberculosis,  summer  diarrhea  or  of 
septicaemia. 

Danger  from  all  these  sources  is  obviated  if  the  milk 
is  pasteurized  before  it  is  given  to  the  infant.  It  should 
be  pasteurized  in  small  bottles  sealed  with  cotton  and  served 
in  these  same  bottles  as  soon  afterward  as  possible. 

The  Freeman  pasteurizer  is  one  of  the  simplest  and  most 
practical.  Many  milk  companies  are  now  selling  pasteur- 
ized milk. 

Mind  Failure. — All  diseases  of  the  mind  and  failures  of 
the  intellect  are  becoming  more  common  every  year,  and 
although  our  present  day  medical  men  know  more  accu- 
rately how  to  treat  insane  persons,  yet  our  asylums  become 
more  and  more  crowded,  and  extra  asylums  for  lunatics 
are  built  every  year.  There  are  two  chief  reasons  given 
for  this  increase  of  lunacy — one  is  the  high  pressure  at 
which  we  now  live  (see  "Simple  Life"),  and  the  other  is 
the  widespread  prevalence  of  intemperance.  Nearly  three- 
quarters  of  all  mad  persons  who  have  not  inherited  insanity 
have  drunk  to  excess. 

A  man  may  be  said  to  be  insane  when  his  conduct  con- 
tinues to  be  markedly  out  of  touch  with  his  surroundings 


MISCARRIAGE,  CAUSES  OF  197 

and  with  his  neighbors'  ways.  Physicians  are  often  able 
to  detect  the  signs  of  a  coming  attack  of  madness  before 
they  are  noticeable  by  other  persons.  It  is  not  usual  for 
madness  to  appear  quite  suddenly,  except  when  persons 
mad  with  drink  get  delirium  tremens,  and  then  pass  on 
into  the  state  of  mania.  Neglect  of  suitable  treatment  in 
the  early  stages  of  insanity  defers  the  time  of  recovery 
in  a  very  marked  manner.  Epileptic  persons,  after  a  long 
course  of  fits,  are  very  apt  to  drift  into  madness. 

Insane  persons  fall  into  several  classes,  as,  for  example : — 

(1)  Maniacs   characterized   by   excitement,    violence,    and 
passions,  want  of  sleep,  causeless  attacks  of  anger,  neglect 
of  duties,  and  distrust  of  relatives  and  friends ;  disordered 
reason  and  confusion  of  ideas.     Such  patients  are  often 
mischievous,  and  will  injure  their  friends  and  attendants. 

(2)  Melancholies.     These   are  in  a  state   of  sadness  and 
gloom ;  they  despair  of  all  things,  often  refuse  food,  will 
not  talk  to  others,  and  sit  alone  in  solitude.     (3)  Demented 
persons.     These  have  lost  whatever  intellect  and  mental 
power  they  may  have  had ;  they  are  weak-minded,  like  chil- 
dren ;  have  dirty  habits,  and  cannot  understand  the  common 
decencies  of  life.     Memory  is  lost,  not  so  much  of  the  great 
events  of  their  lives,  but  of  the  happenings  of  the  last  few 
hours.     (4)  Monomaniacs,   who   have   peculiar  ideas,    de- 
sires and  actions  in  some  special  direction.     For  example, 
some  think  of  nothing  but  religion,  others  only  of  love- 
making;  others,  again,  are  possessed  with  the  wish  to  set 
fire  to  buildings ;  others  seek  to  kill  men  and  women  around 
them;  and  a  last  class  are  suicidal.     (5)   The  fifth  class  are 
sufferers  from  paralytic  insanity — a  disease  which  runs  a 
short  course,  and  is  shown  by  a  gradual  onset  of  palsy, 
accompanied  by   insane   thoughts   and   actions.     In   these 
cases  the  sufferers  are  often  full  of  self-esteem,  and  think 
themselves  gods,  and  kings,  or  millionaires;  they  lose  the 
power  of  speech,  and  in  a  gradual  manner  paralysis  spreads 
all  over  their  limbs;  they  become  mere  animals,  and  sink 
into  death.     (See  also  ''Madness.") 

Miscarriage,  Causes  of. — By  miscarriage  is  popularly 
meant  the  birth  of  a  child  long  before  its  time,  and  before 
the  pregnancy  is  seven  months  old. 

About  37  per  cent,  of  child-bearing  women  miscarry  be- 
fore they  are  thirty ;  and  it  is  commonest  before  the  fourth 
month.  The  causes  may  be  classified : — 


198  MOSQUITOES 

(1)  Causes  due  to  the  father — syphilis,  malaria,  etc.; 

advanced  age. 

(2)  Causes  existing  in  the  mother — syphilis  and  fevers, 

jaundice,  albumin  in  urine  (kidney  disease), 
severe  morning  sickness;  too  long  suckling  of 
previous  child ;  severe  rheumatism ;  mental  shock 
or  worry;  diseases  of  the  womb;  heart  or  liver 
disease ;  direct  violence. 

(3)  Causes  in  the  unborn  child — its  death ;  its  strangu- 

lation in  the  womb. 

Abortion. — To  "procure  an  abortion"  is  to  cause  a  child 
to  be  born  before  its  due  time ;  and  this  is  a  serious  crime, 
whether  committed  by  the  mother  who  bears  the  child  or 
by  any  other  person  except  the  doctor.  A  properly  quali- 
fied medical  man  may  induce  premature  labor,  if,  after 
consultation  with  another  medical  man,  he  decides  that  to 
allow  pregnancy  to  continue  until  full  term  would  prob- 
ably or  certainly  prove  fatal  to  the  mother.  But  in  any 
case  the  proceeding  is  a  violation  of  nature,  and  is  very 
often  followed  by  chronic  ill-health.  There  are  certain 
drugs  sold  by  unscrupulous  herbalists  to  women  for  the 
purpose  of  abortion.  Not  only  do  they  fail  in  their  in- 
tended effect,  but  they  invariably  produce  local  disturbance, 
and  sometimes  even  lifelong  illness.  The  advertisements  of 
such  unscrupulous  and  heartless  quack  medicine  vendors 
are  easily  recognized,  as  they  generally  profess  to  "remove 
obstructions. ' ' 

Mortification. — (See  ' '  Gangrene. ") 

Mosquitoes. — It  has  recently  been  discovered  that  certain 
kinds  of  mosquitoes  are  the  sole  means  of  the  transmission 
of  malaria. 

Other  diseases  which  they  are  capable  of  transmuting  in 
southern  climates  are  yellow  fever,  break-bone  fever,  and 
filariasis — the  cause  of  elephantiasis. 

When  we  reflect  how  simple  are  the  precautions  necessary 
to  annihilate  this  pest,  and  how  effective  when  carried  out 
properly,  we  realize  that  there  is  no  excuse  for  anyone  get- 
ting malaria  or  these  other  diseases. 

They  may  be  gotten  rid  of  by  three  methods — drainage, 
kerosene,  or  fish  which  devour  their  larvae. 

Mosquitoes  cannot  breed  except  in  water.  Therefore,  if 
stagnant  water  is  done  away  with  there  can  be  no  mos- 


MUMPS  199 

quitoes.  The  eggs  are  laid  on  the  surface  of  the  water 
and  hatch  out  as  little  black  wrigglers  which  live  in  the 
water  for  several  weeks  until  they  finally  become  trans- 
formed into  mosquitoes. 

The  following  are  the  methods  used  to  prevent  their 
breeding : — 

Ditching — to  drain  stagnant  pools,  puddles  or  marshes. 
Clear  away  old  cans,  pans  which  collect  water,  and  repair 
gutters  in  which  water  collects.  Screen  barrels,  tanks 
and  cisterns.  Weeds  and  shrubbery  in  which  the  mos- 
quitoes can  find  a  dark,  cool  place  to  hide  during  the  hot 
part  of  the  day,  or  when  the  wind  blows,  should  be  cut 
down. 

When  pools  of  water  cannot  be  drained,  it  is  an  easy 
matter  to  kill  all  young  mosquitoes  in  them  by  pouring  a 
little  kerosene  on  the  water.  If  the  kerosene  is  washed 
away  by  rains  it  must  be  renewed  in  ten  days,  before  any 
mosquito  eggs  have  been  developed  into  adult  mosquitoes. 

Minnows,  goldfish  and  other  fish  feed  on  the  mosquito 
larva?,  so  by  introducing  these  into  a  pond  the  number  of 
mosquitoes  that  breed  there  may  be  greatly  lessened. 

Whenever  a  person  is  suffering  from  malaria  or  yellow 
fever  he  should  be  screened  so  that  he  cannot  be  bitten  by 
mosquitoes  which  may  become  infected  and  later,  by  biting 
other  people,  convey  the  disease  to  them. 

Mothers5  Marks.— (See  "Birthmarks.") 

Mucous  Membranes. — The  mucous  membrane  is  practi- 
cally to  the  inside  of  the  body  what  the  skin  is  to  the 
outside.  It  is  the  thin  lining  of  the  inside  of  the  body, 
of  the  inside  of  the  mouth  and  lips  and  nostrils,  and  of 
the  rectum  and  of  the  urethra,  and  of  the  womb.  It  is 
always  moist,  because  it  is  lubricated  with  mucus;  and 
pink,  because  it  is  so  thin  that  you  can  see  the  color  of 
the  blood  through  it.  (See  "Polypus.") 

Mumps. — This  is  a  very  contagious  ailment,  occurring 
only  once  in  the  same  individual,  as  a  rule  about  two  or 
three  weeks  after  exposure  to  the  infection.  The  patient 
first  feels  "out  of  sorts,"  and  has  a  rather  sore  throat. 
Then  comes  swelling  of  the  gland  round  and  below  the 
lobe  of  the  ear,  and  then  of  the  glands  beneath  the  jaw 
on  each  side.  There  are  feverishness  and  faceache  too, 
and  the  patient  cannot  chew  or  swallow  properly.  These 
symptoms  subside  in  about  a  week  and  then  convalescence 


200  NERVOUS  DEBILITY 

begins ;  but  in  some  cases  this  stage  is  unpleasantly  marked 
by  swelling  of  the  testicles  (in  males),  or  of  the  breasts 
and  ovaries  (in  females),  and — rarely — these  temporary 
swellings  may  result  in  atrophy  (wasting  away)  of  one  of 
the  organs  affected. 

Patients  with  mumps  ought  to  be  isolated  so  that  other 
children  do  not  catch  the  disease,  and  they  must  not  be 
allowed  to  mix  with  their  companions  again  till  after  four 
weeks  have  elapsed  from  the  beginning  of  the  disease.  No 
special  treatment  is  required,  except  that  dictated  by 
commonsense.  Poultices  may  be  needed  to  relieve  the  face- 
ache,  and  a  doctor  should  be  called  in  if  the  testicles  or 
breasts  become  swollen. 

Mussels. — Unwholesome  mussels  may  cause  nausea,  vom- 
iting, and  severe  purging,  leading  to  rapid  exhaustion. 
These  poisonous  effects  may  arise  either  from  the  mussels 
being  stale  and  decaying,  or  from  their  having  been  col- 
lected out  of  water  rendered  impure  by  sewage  contamina- 
tion, or  because  they  have  grown  upon  timber  containing 
copper  nails,  or  sheathed  with  copper  as  often  occurs  in 
docks  and  locks.  The  poisonous  material  needs  to  be  re- 
moved by  vomiting,  so  give  emetics  (see  list)  of  ipecac- 
uanha, zinc  sulphate,  mustard  and  water,  and  also  a  brisk 
purgative  dose  when  the  sickness  is  over,  such  as  castor  oil 
(two  tablespoonfuls),  or  black  draught  of  Epsom  salts  and 
senna;  if  there  is  much  collapse,  brandy  (a  tablespoonful 
in  a  little  water,  repeated  in  15  minutes)  will  be  needed. 

Nervous  Debility. — A  great  number  of  people  are  always 
complaining  of  being  weak  and  nervous;  indeed,  the  state 
of  nervous  debility  seems  to  be  the  most  common  of  all 
ailments  nowadays,  and  the  young,  who  ought  to  be  strong, 
seem  to  suffer  more  often  than  those  who  are  past  middle 
life  and  might  reasonably  be  expected  to  be  feeling  the 
weakness  of  old  age  gradually  coming  on. 

There  are  hundreds  of  quack  medicines  which  are  war- 
ranted to  cure  this  state  of  ill-health;  but  we  fear  that 
they  are  not  very  successful.  The  symptoms  of  this  nerv- 
ous weakness  as  recounted  in  advertisements  are  general 
weakness,  and  loss  of  appetite,  headaches,  and  sleeplessness; 
indigestion,  flushings  of  heat  in  the  face,  and  coldness  of 
the  feet  and  hands;  nervous  tremblings,  and  a  feeling 
of  timidity  and  bashfulness  before  strangers.  This  is  a 
long  catalogue  of  very  indefinite  symptoms,  and  if  you 


NETTLERASH  201 

really  are  weak  and  nervous  and  have  some  of  these  symp- 
toms, you  can  readily  fancy  all  the  others.  Nervous  per- 
sons can  fancy  almost  anything  they  hear  spoken  of,  and 
many  people  of  that  sort  fancy  they  have  heart  disease 
all  their  lives  without  having  anything  at  all  the  matter 
with  their  hearts.  Such  people  generally  have  "wind  in 
the  stomach, ' '  and  they  fancy  that  the  pain  comes  from  the 
heart.  Nervous  debility  can  generally  be  cured  more  read- 
ily by  leading  a  simpler  life,  with  a  proper  share  of  whole- 
some food,  ample  open-air  exercise,  and  cold  baths  than 
by  any  tonic  or  medicine,  however  much  advertised,  pro- 
vided the  patient  will  avoid  the  pleasant  dangers  of  drink- 
ing and  over-much  smoking.  Sensible  people  who  have  no 
actual  disease  of  any  organs  can  be  their  own  doctors,  but 
when  there  is  actual  organic  disease  sensible  persons  will 
not  attempt  to  treat  themselves.  If  you  feel  nervous  de- 
bility, examine  yourself,  and  consider  what  kind  of  life 
you  have  led,  and  what  has  caused  your  weak  state.  Is  it 
from  any  excesses,  or  late  hours,  or  want  of  fresh  air? 
Or  is  it  from  irregular  meals,  or  from  cigarette-smoking, 
or  from  an  unhealthy  home  ?  Or  is  your  weak  state  heredi- 
tary— has  it  come  down  to  you  from  your  parents?  In 
any  case,  remove  the  cause,  if  you  can  find  it.  Women 
are  often  weak  and  ailing  from  drinking  too  much  tea,  or 
from  drinking  tea  habitually  which  has  been  made  too  long 
before  use,  for  in  that  case  the  hot  water  has  soaked  much 
tannin  out  of  the  leaves,  and  tannin  injures  the  coats  of 
the  stomach,  and  lessens  the  appetite.  There  are  occasions, 
no  doubt,  when  a  short  course  of  tonic  medicines,  such  as 
quassia,  gentian,  cinchona  bark,  and  quinine,  will  do  much 
good;  but  do  not  rely  on  them  too  much,  nor  continue  to 
take  them  too  long.  Live  as  simply  and  naturally  as  pos- 
sible, and  avoid  drugs  as  much  as  you  can,  and  do  not  take 
to  drops  of  wine  and  spirits  to  keep  you  up,  because  they 
will  gradually  make  you  worse  than  ever.  Rest  when  you 
can,  and  get  a  change  of  air  and  scene  whenever  possible, 
and  spend  as  much  time  as  possible  in  the  open  air  and 
sunshine  (see  also  "Neurasthenia"). 

Nettlerash. — The  medical  name  for  this  form  of  skin 
affection  is  Urticaria,  from  the  Latin  name  for  nettle,  and 
is  so  called  because  this  peculiar  skin  rash  resembles  the 
white  marks  which  are  caused  on  a  person's  skin  by  being 
stung  with  the  leaves  of  the  nettle  plant. 


202  NEURALGIA 

Nettlerash  may  occur  in  healthy  persons  as  well  as  in 
invalids,  and  is  generally  found  to  have  been  caused  by 
some  errors  in  diet,  or  by  some  unwholesome  food,  or  by 
chills. 

The  characteristic  signs  are  the  appearance  of  bright  red 
patches  or  wheals  on  the  skin;  these  are  slightly  raised, 
but  smooth  and  flat,  and  have  no  pimples  nor  vesicles  on 
them,  no  sores,  no  discharge,  and  no  scurfiness. 

The  wheals  are  red  at  first,  and  then  change  a  little,  be- 
coming pale  and  white  in  the  middle,  with  a  ring  of  pink- 
ness  around  them;  and  as  the  wheal  subsides  the  edges 
grow  pale,  and  are  pink  in  the  center.  They  vary  in  shape, 
and  may  be  seen  any  size,  from  a  threepenny  piece  to  the 
size  of  the  palm.  A  patch  may  last  only  an  hour,  or  per- 
haps for  a  day,  or  even  longer.  The  wheals  burst  out 
quite  suddenly,  and  are  accompanied  by  a  feeling  of  heat 
and  by  itching.  Scratching  gives  only  momentary  relief, 
and  in  some  cases  fresh  wheals  show  up  wherever  the  skin 
is  scratched. 

The  attack  may  be  quite  local,  or  it  may  be  accompanied 
by  feverishness.  The  rash  may  last  for  days,  fresh  crops 
coming  out  every  few  hours.  Chronic  cases  are  sometimes 
seen,  in  which  there  may  be  occasional  crops  of  skin  rash 
every  few  days  for  months  or  years. 

This  disease  occurs  chiefly  in  persons  of  a  nervous  tem- 
perament, and  is  often  found  to  accompany  asthmatic  at- 
tacks. Persons  who  are  habitually  intemperate  frequently 
suffer  from  it,  and  so  do  gouty  persons.  It  is  very  com- 
mon among  infants.  Violent  emotions  of  the  mind,  pas- 
sions, and  terror  may  bring  on  an  attack,  especially  in 
children.  Unwholesome  food  is,  however,  the  usual  cause; 
tainted  meat,  high  game,  shellfish,  such  as  mussels  and 
oysters,  crabs  and  lobsters,  and  mushrooms,  are  among  the 
commonest  irritants  which  disorder  the  stomach  and  in- 
testines, and  bring  out  a  nettlerash;  and,  lastly,  children 
with  worms  often  suffer.  As  to  treatment,  of  course  the 
first  necessity  is  to  find  out  and  remove  the  cause;  if  it 
comes  out  directly  after  suspicious  food,  give  an  emetic; 
if  later,  give  a  sharp  purge  of  black  draught.  For  some 
days  take  low  diet,  and  a  rhubarb  and  soda  mixture,  and 
apply  eau-de-cologne  as  a  lotion,  or  zinc  ointment. 

Neuralgia. — "Neuralgia,"  said  a  wise  physician,  "is  the 
prayer  of  a  nerve  for  healthy  blood."  From  this  we  learn 


NEURALGIA  203 

that  the  real  cure  for  neuralgia  lies  in  the  improvement 
of  the  general  health  of  the  body,  and  not  in  rubbing  in 
something  to  ease  the  pain — though  that  is  necessary- 
enough  sometimes.  Neuralgia  is  not  a  disease,  but  a  sign 
of  disease,  of  some  organ  or  nerve.  Every  doctor  does  his 
best  to  discover  the  cause  of  the  neuralgia  first.  In  the 
meantime,  until  he  has  found  it  he  relieves  the  pain  as 
much  as  he  can. 

Ancemia  is  a  great  cause  of  neuralgia.  If  a  woman  is 
anemic,  let  her  try  the  following  medicine  for  her  neuralgic 
pains : — Reduced  iron,  4  grains ;  arseniate  of  iron,  y8  grain ; 
sulphate  of  quinine,  1%  grains;  ingredients  for  one  pill. 
Take  one  of  these  pills  after  each  meal  (thrice  daily)  and 
two  at  bedtime.  Continue  this  for  a  month  or  more.  But 
the  bowels  must  be  kept  freely  open  every  day  all  the  time ; 
otherwise  the  pills  will  be  useless. 

Gout,  Rheumatism  and  Syphilis  are  very  common  causes 
of  neuralgia.  Of  course,  they  must  be  dealt  with  accord- 
ing to  their  nature  in  each  case.  Lead  poisoning  is  another 
frequent  cause. 

The  local  treatment  of  neuralgia  is  important.  We  shall 
give  here  several  useful  formulae,  reminding  the  patient 
once  again  that  it  is  wise  to  consult  a  doctor  first  of  all, 
and  find  out  from  him  what  is  likely  to  be  the  cause  of  the 
neuralgia,  and  what  steps  ought  to  be  taken.  These  re- 
marks apply  specially  to  the  dentist  as  well. 

The  fact  that  there  are  hundreds  of  recognized  medicines 
in  daily  use  (in  treating  neuralgia),  as  well  as  hundreds 
of  quack  remedies  which  are  all  said  to  "cure"  without 
delay,  will  prove  to  the  reader  that  the  treatment  of  neu- 
ralgia is  difficult  in  very  many  cases.  We  hope  that  some- 
thing in  the  following  list  may  be  useful  to  sufferers  who 
have  failed  to  obtain  relief  from  either  doctors  or  quacks, 
and  who  are  willing  to  take  the  risks  which  must  always 
fall  to  the  lot  of  those  who  "pour  medicines,  of  which  they 
know  little,  into  bodies  of  which  they  know  less. ' ' 

For  Neuralgia  of  the  face  and  brow. — Morphine  hydro- 
chlorate,  y$  grain;  sulphate  of  quinine,  5  grains;  chloride 
of  ammonium,  15  grains  (contains  poison).  Mix,  and 
make  a  powder,  to  be  swallowed  in  a  cachet  twice  a  day. 
(Requires  a  doctor's  prescription.) 

For  Neuralgia  of  the  gums  and  jaws.  Tincture  of  gel- 
semium,  15  minims;  water  to  one  ounce.  Make  four  such 


204  NEURASTHENIA 

doses.  Take  two  tablespoonfuls  of  the  medicine  every  six 
hours.  (Should  not  be  taken  without  a  doctor's  advice.) 

For  General  Neuralgic  or  Rheumatic  Pains. — Fellowes' 
sirup  of  the  hypophosphites.  Liniments  to  be  rubbed  into 
the  painful  spot: — Linimentum  Aconiti  (poisons  if  taken 
internally)  ;  or,  Menthol  3,  chloroform  3,  olive  oil  enough, 
to  16  parts;  or,  compound  camphor  liniment  (poison)  ;  or, 
Baume  Analgesique  Bengue. 

If  all  medicines  fail,  recourse  may  be  had  to  (1)  Elec- 
tricity, the  results  are  generally  disappointing;  or,  (2) 
Operation.  The  various  operations  which  have  been  done 
to  relieve  neuralgia  include  nerve-stretching,  nerve-cutting 
in  different  ways,  nerve-tearing,  and  nerve-ligature  (ty- 
ing). Lastly,  (3)  Hypnotism. 

Neurasthenia  is  a  very  common  complaint  nowadays. 
It  is  the  medical  word  for  nerve  exhaustion,  and  it  is 
caused  in  different  ways.  The  tendency  of  the  age  is  to- 
wards brain  work,  and  brain  workers  therefore  have  to 
contend  against  enormous  competition.  The  weak-nerved 
among  them  therefore  break  down  sometimes.  Then  comes 
the  abuse  of  stimulants — alcohol  and  tobacco,  which  are 
taken  to  whip  up  the  tired  brain — and  then  comes  nervous 
breakdown.  The  neurasthenic  man  or  woman  has  usually 
been  a  hard,  honest  worker,  and  when  the  breakdown  comes 
he  tries  to  hide  it  and  does  not  ask  for  sympathy.  Even 
if  the  breakdown  is  due  to  excesses  and  debauchery  instead 
of  to  hard  work  he  tries  to  hide  it,  and  to  overcome  it. 
With  hysteria,  it  is  different.  She  (it  is  generally,  but  not 
always,  a  woman)  is  idle  and  probably  plump  and  well- 
nourished,  and  craves  for  sympathy ;  in  fact,  she  will  stoop 
to  almost  any  deception  to  get  the  pity  and  sympathy  she 
craves.  Her  aches  and  pains  and  sleepless  nights  are 
mostly  imaginary,  though  she  at  last  begins  to  deceive 
even  herself,  and  she  pities  and  loves  herself  sincerely. 
The  neurasthenic  man  or  woman  suffers  from  a  feeling  of 
oppression  at  the  top  of  the  head,  a  poor  memory,  sleep- 
lessness, irritability,  fear  of  being  in  open  spaces  in  the 
streets,  and  melancholy.  He  may  be  wasted  in  body.  The 
two  diseases,  neurasthenia  and  hysteria,  are  generally  quite 
distinct,  but  in  women  both  may  be  present  together. 
When  they  are  distinct  they  differ,  as  we  have  said,  in  the 
attitude  of  the  patients  towards  sympathizers ;  and  in  this 
— that  hysterical  women  are  very  difficult  to  cure  because 


NEURITIS,  ALCOHOLIC  205 

they  often  do  not  really  desire  to  be  cured,  whereas  neuras- 
thenic people  wish  with  all  their  hearts  to  be  cured  so  that 
they  may  be  able  to  resume  their  work. 

The  proper  treatment  of  neurasthenia  requires  time. 
First,  there  ought  to  be  a  complete  change — a  change  of 
scene,  of  air,  of  occupation  and  of  faces.  This  partly  ful- 
fills the  second  requirement,  which  is  rest,  which  ought  to 
be  absolute.  There  ought  to  be  absolutely  no  business 
worries,  no  business  letters  and  nothing  to  do  but  idle  the 
time  away.  The  third  requirement  is  plenty  of  food  and 
fresh  air.  And  this  method  of  treatment  which  is  so  good 
for  the  neurasthenic  is  the  worst  possible  for  the  hysterical 
person.  (See  ''Hysteria.") 

Neuritis,  Alcoholic. — This  is  fairly  common,  especially  in 
women  who  drink  spirits  to  excess  in  secret.  It  begins  with 
pains  or  cramps  and  tenderness  of  the  muscles,  especially 
those  of  the  calves  of  the  legs;  and  the  patients,  who  love 
their  pet  vice,  prefer  to  believe  that  the  pain  is  rheumatism ; 
and  that  it  is  not  alcohol  which  is  making  them  ill.  In 
fact,  they  drink  more  alcohol  to  relieve  the  pains!  Then 
come  tingling  and  numbness,  or  burning  pains  in  feet  and 
hands,  and  some  weakness,  which  may  or  may  not  become 
actual  paralysis.  If  the  patient  will  leave  off  drinking 
she  may  recover  completely,  but  otherwise  the  trouble  will 
increase;  and  she  will  become  suspicious  and  disagreeable 
and  fretful,  and  believe  ill  of  everybody,  and  fancy  that 
people  are  persecuting  her.  It  often  happens  that  in  these 
cases  the  relations  and  friends  cannot  imagine  what  is  hap- 
pening to  the  patient  or  what  makes  her  so  ill  and  disagree- 
able. A  doctor  will  often  suspect  a  woman  of  secret  drink- 
ing for  months  or  years  before  he  is  able  to  find  her  out. 
He  may  feel  sure  all  the  time  that  her  illness  is  caused  by 
the  spirit-drinking,  and  yet  be  unable  to  make  her  confess 
to  it.  A  woman  who  drinks  to  excess  is  the  worst  of  liars, 
and  there  is  hardly  a  depth  of  meanness  or  deception  to 
which  she  will  not  stoop  to  obtain  and  conceal  the  drink 
which  is  poisoning  her  blood. 

Treatment. — The  first  thing  to  do  is  to  deprive  the  pa- 
tient at  once  of  all  alcoholic  liquor.  This  is  sound  treat- 
ment, though  if  terrible  depression  follows,  or  vomiting  or 
delirium  takes  place,  the  patient  and  her  friends  will  very 
likely  attribute  the  new  trouble  to  the  sudden  deprivation 
of  alcohol  instead  of  to  its  real  cause,  the  alcohol  itself. 


206  NIGHTMARE 

But  even  though  the  patient  protests  that  she  will  die  if 
she  doesn't  get  more  drink  it  must  be  withheld  or  she  will 
not  recover. 

There  are  exceptions  to  this  rule,  however,  which  the 
experience  of  a  doctor  only  can  decide.  To  allay  the  crav- 
ing for  drink  which  now  begins  with  great  fury,  food  must 
be  given  by  a  firm  nurse  every  hour,  or  thereabouts — a 
little  liquid  food  of  some  kind  in  small  quantities  at  short 
intervals.  Then  a  teaspoonful  of  the  following  medicine 
should  be  given  in  soda-water  every  hour  while  the  craving 
is  intense : — Spirit  aromatic  of  ammonia,  4  ounces ;  tincture 
of  cinchona,  2  ounces;  solution  of  hydrochloride  of  strych- 
nine, 1  drachm;  tincture  of  capsicum,  1  ounce.  (Poison.) 

Then,  as  to  the  local  treatment  of  the  neuritis,  rest  in 
bed  is  necessary,  and  cocaine  injections  under  the  skin  very 
often  give  much  relief.  In  bad  cases  the  sufferer  must  lie 
on  a  water-bed.  Twice  a  day  hot  fomentations  ought  to  be 
applied  to  the  most  painful  parts  of  the  limb,  and  after 
being  dried  well,  the  limb  must  be  wrapped  in  cottonwool 
or  woodwool  tissue.  Warm  baths  are  often  comforting. 
When  the  pain  is  better  the  wasted  muscles  need  electrical 
treatment  or  massage.  Note. — Neuritis  is  not  caused  only 
by  alcoholic  excess,  though  that  is  by  far  the  most  common 
cause ;  nor  does  it  occur  only  in  women.  Men  are  liable 
to  it  also,  and  especially  those  whose  work  brings  them  in 
contact  with  certain  chemical  poisons,  such  as  arsenic,  lead, 
mercury,  silver,  etc.,  and  those  who  are  afflicted  with  gout, 
gonorrhea,  syphilis,  influenza,  beri-beri,  diabetes.  (See 
also  ' '  Lead-poisoning. ' ' ) 

Neurosis. — This  word  means  a  ' '  nervous ' '  condition  which 
is  not  caused  by  any  discoverable  alteration  in  the  brain, 
spinal  cord,  or  nerves.  Such  diseases  are  hysteria,  asthma, 
neurasthenia.  A  family  is  said  to  be  neurotic  when  there 
is  a  family  history  of  one  of  the  neuroses.  Madness  in  some 
forms  is  a  neurosis. 

Nightmare. — Horrible  dreams,  as  of  falling  over  a  preci- 
pice, being  strangled,  being  crushed,  and  so  on,  are  gen- 
erally due,  in  adults,  to  too  much  supper  or  to  such  items 
of  diet  as  cucumber,  pastry,  mayonnaise,  pickles  and  cheese. 
We  all  remember  how  Scrooge,  in  that  wonderful  old  story 
of  Dickens',  believed  that  Marley's  Ghost  was  nothing  but 
a  nightmare,  and  told  him  that  he  (the  Ghost)  might  be 
nothing  more  than  an  undigested  bit  of  beef.  Some  adults 


NOISES  IN  THE  EARS  207 

have  these  dreams  only  when  they  sleep  on  their  backs, 
and  they  should  tie  an  empty  cotton-reel  around  the  waist 
to  prevent  their  being  comfortable  on  their  backs. 

Night-Terrors. — These  occur  in  nervous  and  excitable 
children,  especially  those  of  precocious  intelligence,  whose 
active  little  brains  give  them  vivid  dreams.  The  doctor 
must  be  consulted  in  every  case  of  these  "terrors"  in  chil- 
dren. The  cause  must  be  looked  for.  It  may  be  nothing 
more  serious  than  the  irritation  of  the  nervous  system 
caused  by  teething ;  or  by  worms  in  the  bowels ;  or  by  indi- 
gestion. But  the  terrors  may  be  due  to  some  foolhardy 
and  ignorant  nurse-girl  who  tells  the  children  ghost  stories 
or  threatens  absurd  punishments  for  naughtiness.  Chil- 
dren who  are  very  sensitive  should  not  be  put  to  bed  in  a 
quite  dark  room — there  should  always  be  a  night-light. 
Adenoid  growths  seem  to  "predispose"  to  night-terrors. 
No  medicine  should  be  given  in  these  cases  without  the  ex- 
press orders  of  the  family  doctor. 

Night  Sweats. — Children  with  rickets  often  perspire  very 
much  at  nights,  especially  about  the  head  and  neck.  The 
treatment  is  the  general  treatment  for  rickets. 

Persons  with  consumption  of  the  lungs  sometimes  wake 
up  drenched  with  perspiration.  This  is  very  weakening  if 
it  continues  long.  The  following  pill,  given  at  bedtime, 
will  stop  the  sweating  in  many  cases: — Oxide  of  zinc,  2 
grains ;  extract  of  belladonna,  %6  grain ;  extract  of  hyoscya- 
mus,  1  grain.  To  make  12  pills. 

If  this  fails,  however,  try  picro toxin  (see  "Consump- 
tion") or  give  five  grains  of  sulphonal  at  bedtime  instead. 
If  there  is  diarrhea  as  well  as  sweating  the  patient  will 
improve  on  10  grain  doses  of  calcium  phosphate. 

Noises  in  the  Ears. — The  treatment  of  these  must  depend 
upon  the  cause,  which  may  be  wax  in  the  ear,  a  polypus, 
catarrh,  decayed  teeth  or  some  other  unexpected  condition. 
We  can  only  give  a  prescription  or  two  in  the  hope  of 
relieving  some  who  suffer  from  this  distressing  symptom. 
First,  however,  let  the  sufferer  get  the  ear  well  cleaned  out 
by  syringing  with  boric  acid  lotion.  (Also  see  "Ear  Dis- 
eases.") 

(1)  Apply  a  blister  behind  the  ear;  or,  (2)  rub  veratrine 
ointment  into  the  skin  round  the  ear;  or,  (3)  take  ten 
minims  of  the  tincture  of  digitalis  in  water  every  four 
hours;  or,  (4)  take  fifteen  grains  each  of  ammonium  bro- 


208  OYSTERS,  RISK  OF  EATING 

mide  twice  a  day.  (5)  Fowler's  solution,  1  drachm; 
bromide  of  sodium,  2  ounces ;  aromatic  spirits  of  ammonia, 
2  ounces;  camphor  water  to  12  ounces.  Take  one  table- 
spoonful  of  the  mixture  thrice  daily  after  meals.  Of 
course,  before  beginning  with  any  of  these  medicines  the 
sufferer  will  make  sure  by  getting  the  advice  of  an  aurist 
that  there  is  no  local  curable  condition. 

Nose-Bleeding  may  occur  from  knocks  or  blows,  or  from 
over-fullness  of  the  blood  vessels.  In  moderate  quantity 
it  rarely  does  any  harm,  and  is  checked  by  bathing  the 
face  with  cold  water,  while  the  patient  sits  down  quietly; 
loosen  the  collar,  and  calm  him,  if  alarmed.  The  sudden 
application  of  cold,  such  as  of  a  cold  laundry  iron,  to  the 
bare  back  between  the  shoulder  blades,  often  stops  the 
bleeding  by  giving  a  shock  to  the  nervous  system.  Nose- 
bleeding  may  occur  in  women  instead  of  some  other  usual 
loss  of  blood,  and  even  in  pregnancy,  in  a  similar  way. 
Some  persons  are  born  with  a  special  liability  to  bleed, 
especially  at  the  nose.  After  middle-age,  nose-bleeding 
often  shows  a  dangerous  state  of  internal  congestion  and 
averts  an  attack  of  apoplexy. 

Never  allow  a  person  with  nose-bleeding  to  hang  his  head 
over  a  basin.  Keep  the  head  high  and  apply  cold  to  the 
nape  of  the  neck.  When  simple  treatment  fails  to  check 
nose-bleeding,  it  is  necessary  to  spray  the  inside  of  the 
nostrils  with  an  astringent  lotion,  such  as  alum  in  water 
— a  teaspoonful  to  a  tumbler.  In  cases  of  violent  bleeding, 
which  you  cannot  stop,  you  may  paint  the  inside  of  the 
bleeding  nostril  with  glycerine  of  tannin,  by  a  long,  fine, 
soft  brush,  or  blow  powdered  alum  or  tannin  into  the 
nostrils  from  an  india-rubber  bag,  or  insert  a  cone  of  cotton- 
wool, dipped  in  some  alum  or  tannin  solution,  into  the 
nostrils  with  a  probe.  These  modes  of  treatment,  however, 
require  skilled  hands  and  special  apparatus,  so  a  doctor 
should  be  sent  for.  If  all  these  fail,  the  surgeon  will  have 
to  plug  the  nostrils  behind  as  well  as  in  front  by  means 
of  a  special  instrument  called  a  nasal  sound. 

Overlaying. —  (See  "Babies  Lost.") 

Oysters,  Eisk  of  Eating. — Oysters  are  a  very  nutritious 
food,  and  when  eaten  raw  are  very  digestible,  but  when 
cooked  are  not  suitable  for  invalid  diet.  Oysters  are  grown 
in  shallow  sea  water  at  certain  sandy  places  along  our 
coasts,  and  there  is  always  the  risk  that  they  may  have  been 


PAIN  209 

tainted  with  sewage.  All  sea-coast  towns  drain  into  the 
sea  and  very  often  there  are  currents  which  carry  foul 
matters  along  the  coasts  instead  of  more  directly  into  the 
ocean.  Contaminated  oysters  cannot  be  distinguished 
either  by  sight  or  smell,  but  when  eaten  may  give  rise  to 
attacks  of  typhoid  fever,  which  may  end  fatally;  such  at- 
tacks may  not  show  themselves  for  a  week  or  two  after 
taking  the  poisoned  oysters. 

Pain. — Students  of  human  nature  will  probably  agree 
with  almost  complete  unanimity  that  since  the  world  began 
mankind's  greatest  curse  has  been  pain;  yet,  paradoxical 
as  it  may  seem,  very  casual  consideration  will  prove  con- 
vincingly that  this  same  specter  pain  is,  in  reality,  the 
greatest  blessing  ever  bestowed  upon  mankind. 

The  power  of  pain  to  emphasize  the  appreciation  of 
pleasure  (a  dictum  frequently  dwelt  upon  by  the  old  phi- 
losophers) may  be  put  aside  for  the  present,  for  the  impor- 
tance of  pain  has  a  much  more  direct  bearing  upon  the 
subject  here  at  hand. 

It  is  pain  which  calls  the  attention  of  the  human  being, 
no  matter  how  low  in  the  social  order,  to  the  fact  that  he 
is  experiencing  some  abnormal  condition  which  if  not 
heeded  and  corrected  may  result  in  the  cessation  of  his 
earthly  existence.  Not  infrequently  it  is  pain  alone  which 
stands  between  him  and  physical  annihilation  if  this  in- 
dicator is  not  heeded.  For  without  this  symptom,  in  many 
inflammatory  conditions  of  vital  organs,  relief  would  not 
be  sought  until  the  time  had  long  passed  when  hope  of 
relief  from  medical  or  surgical  agencies  would  be  of  avail. 

The  importance  of  pain  as  a  symptom,  then,  having  been 
established,  it  becomes  of  the  greatest  importance  to  the 
average  human  being  to  be  able  to  appreciate  what  forms 
of  pain  may  be  trivial  and  capable  of  relief  by  home  meth- 
ods, and  what  forms  are  serious  and  demand  the  quickest 
possible  relief  by  expert  agencies. 

On  general  principles  it  may  be  stated  that  pains  in  the 
extremities  rarely  immediately  threaten  life  and  may  be 
temporized  with ;  while  pains  in  the  trunk  or  head  may 
indicate  the  involvement  of  a  vital  organ,  and  any  tem- 
porizing may  have  fatal  consequences.  Therefore,  in  at- 
tempting relief  of  such  pains,  the  average  human  being 
should  feel  very  sure  of  his  ground  before  attempting  to 
relieve  such  pains  without  expert  opinion  as  to  its  cause. 


210  PARALYSIS 

Pains  may  be  roughly  divided  into  the  following 
forms : — 

Inflammatory,  neuralgic,  tumors,  foreign  bodies  such  as 
stones,  pressure  pains  (as  e.  g.  aneurism),  chemical  poisons 
and  functional  pains. 

Functional  and  neuralgic  pains  should  only  be  diagnosed 
after  a  process  of  exclusion  of  other  forms,  and  rarely 
prove  fatal.  Any  one  of  the  other  forms,  however,  may 
indicate  a  condition  capable  of  resulting  fatally. 

The  causes  and  treatment  of  the  various  forms  of  pain 
are  best  considered  under  the  various  disease  headings. 
The  interpretation  of  many  pains  is  so  complex  that  only 
a  trained  diagnostician  is  competent  to  adjudge  them  cor- 
rectly. This  is  emphasized  by  the  fact  that  many  pains 
are  "referred  pains"  caused  by  a  condition  remote  from 
the  apparent  site  of  the  pain.  Moreover,  the  most  serious 
conditions  are  not  always  announced  by  the  most  severe 
pain. 

Therefore,  unless  a  pain  is  thoroughly  understood,  do 
not  delay  in  having  its  cause  determined  by  a  competent 
medical  authority,  and  do  not  belittle  this — "God's  great- 
est gift  to  man. ' ' 

Paralysis. — The  old-fashioned  English  name  for  paralysis 
was  palsy,  but  this  word  has  gone  very  much  out  of  use 
of  late  years.  It  will  be  found  in  Bible  stories.  The  word 
means  a  state  of  disease  in  which  there  is  a  loss  of  muscular 
action,  a  loss  of  power  to  move  some  part.  Thus,  for 
example,  there  are  facial  palsies,  in  which  the  face  muscles 
have  lost  their  uses,  and  the  face  on  one  side,  or  both,  is 
expressionless.  Another  variety  is  seen  in  painters  and 
others  who  have  lead  colic;  in  such  patients  we  may  find 
a  partly  useless  hand  or  a  dropped  wrist.  The  most  com- 
mon cases  of  paralysis  are,  first,  those  cases  called  Hemi- 
plegia,  in  which  one  side  of  the  body,  one  arm  and  leg,  are 
palsied,  and,  secondly,  Paraplegia,  in  which  both  legs  are 
palsied,  but  not  the  arms.  The  first  is  due  to  brain  mis- 
chief, either  softening  of  the  brain  or  bleeding  into  the 
brain;  the  second  is  caused  by  disease  or  injury  to  the 
spine.  Either  of  these  diseases  may  be  recovered  from  in 
some  cases,  but  in  others  a  fatal  result  ensues.  Simple 
palsy  of  one  side  may  last  for  years,  and  never  improve; 
some  such  cases  remain  bedridden  all  a  lifetime.  We  can- 
not say  that  any  medicines  have  power  to  cure  palsies,  ex- 


PERSONAL  HYGIENE  211 

cept  those  caused  by  syphilis,  and  when  cases  recover  it  is 
"Nature"  which  effects  the  cure. 

Hemiplegia,  or  paralysis  of  one  side,  is  generally  of  sud- 
den onset,  coming  on  with  an  apoplexy,  commonly  called 
a  fit,  or  a  paralytic  stroke.  (See  "Apoplexy.")  In  such 
cases  a  blood  vessel  has  burst  in  the  brain.  If  of  slow 
onset,  it  is  due  to  the  "softening"  or  decay  of  some  spot 
in  the  brain.  A  sudden  loss  of  the  senses  occurs  often  ac- 
companied by  a  fall;  the  patient  cannot  be  roused,  as  he 
can  from  a  faint ;  also,  instead  of  the  pale  face,  seen  in  one 
who  has  fainted,  there  is  often  a  purple  tint  of  face,  with 
difficult  noisy  breathing.  One  cheek  hangs  loose,  and  the 
other  cheek  is  drawn  aside ;  there  may  be  a  squint,  and  one 
eyelid  may  drop  uselessly.  The  patient  is  unable  to  speak, 
from  part  of  the  tongue  having  lost  its  power ;  saliva  often 
dribbles  away.  When  the  insensibility  passes  off  it  is 
found  that  the  arm  and  leg  of  one  side  cannot  be  volun- 
tarily moved;  they  may  be  flabby  or  stiff.  Some  cases  die 
even  in  the  moment  of  the  fit ;  others  live  for  hours  or  days, 
and  die  without  regaining  consciousness ;  the  result  depends 
upon  the  situation  and  amount  of  the  brain  mischief. 
When  this  is  slight  the  signs  of  recovery  may  come  on  very 
soon,  and  complete  disappearance  of  all  the  symptoms  may 
ensue  in  a  few  days  or  weeks.  But  in  the  majority  of  cases 
some  weakness  (called  Paresis)  is  left,  even  if  there  is  no 
definite  palsy,  and  the  patient  is  an  invalid  who  has  to 
take  great  care  of  himself  for  the  rest  of  his  life.  Elec- 
tricity and  massage  may  be  necessary,  but  not  very  much 
good  is  to  be  hoped  from  electrical  treatment.  Massage  of 
a  paralyzed  limb  is  always  grateful  to  the  sufferer.  The 
possibility  of  a  second  attack  has  to  be  borne  always  in 
mind,  and  the  patient  should  particularly  avoid  excess  of 
alcohol  and  should  live  on  a  very  light  diet. 

Paraplegia  is  commonly  the  result  of  spinal  disease,  espe- 
cially in  children.  And  there  is  another  type  of  paraplegia 
(paralysis  of  the  legs)  with  spasm  added  to  it.  Nothing 
can  be  gained  from  dealing  more  fully  with  these  subjects 
in  this  book.  (See  also  "General  Paralysis.") 

Pathology. — This  is  the  science  which  treats  of  the 
changes  produced  in  the  body  by  disease. 

Personal  Hygiene. — Man's  health  is  maintained  by  car- 
ing for  the  condition  of  his  body  and  his  environment. 
To  the  latter  the  term  sanitation  is  usually  applied. 


212  PERSONAL  HYGIENE 

Hygiene  implies  a  somewhat  closer  association  with  the 
body,  and  by  personal  hygiene  is  meant  care  of  the  body 
which  will  improve  its  physical  condition  and  prevent  the 
contraction  of  disease. 

Personal  hygiene  is  a  large  subject  and  can  be  dealt  with 
fully  only  at  great  length;  but  there  are  a  few  rules  of 
right  living  which  may  be  conveniently  mentioned  in  brief 
—the  observance  of  which  would  do  much  to  diminish  the 
amount  of  sickness  and  ill  health. 

Skin. — This  is  a  protective  against  the  entrance  of  germs 
into  the  body  and  assists  in  the  purification  of  the  blood 
and  the  regulation  of  the  loss  of  heat  from  the  body,  mainly 
by  perspiration. 

It  is  important  to  keep  the  skin  clean  because  dirt  in- 
terferes with  perspiration  and  the  other  skin  functions, 
favors  skin  blemishes,  boils  and  abscesses,  and  the  harbor- 
ing of  parasites  and  germs  of  disease. 

To  this  end  a  daily  cleansing  bath  of  hot  water  with 
soap  is  advised — preferably  at  night. 

Mouth. — The  mouth  harbors  many  of  the  germs  of  dis- 
ease— even  when  the  person  feels  perfectly  well.  If  any- 
thing occurs,  however,  to  lower  this  person's  resistance  to 
disease — as  e.  g.,  chilling — these  germs  may  obtain  a  foot- 
hold and  cause  disease.  Therefore  efforts  should  be  made 
to  keep  the  mouth  as  germ  free  as  possible  by  the  use  sev- 
eral times  daily  of  some  pleasant  mouth  wash  or  antiseptic 
such  as  listerine,  glycothymoline,  borine,  alkalol,  borolyptol 
or  alkaline  antiseptic  fluid  of  the  pharmacopeia. 

Lungs  and  Nose. — The  air  of  cities  is  full  of  germ-laden 
dust.  To  prevent  the  entrance  of  this  dust  into  the  lungs 
breathing  should  be  done  entirely  through  the  nose  where 
there  is  a  filtering  apparatus  capable  of  removing  dust  im- 
purities from  the  inspired  air. 

The  air  thus  inspired  is  also  warmed  before  it  reaches 
the  lungs. 

Dust  which  is  removed  from  the  air  by  the  nasal  filter 
should  be  removed  from  the  nose  at  least  twice  a  day  by 
the  use  of  a  nasal  douche  containing  a  weak  antiseptic 
solution  such  as  dilute  glycothymoline,  alkalol  or  boracic 
acid. 

If  the  nasal  passage  is  obstructed,  the  obstructions  should 
be  removed.  The  commonest  form  of  obstruction  in  the 
naso-pharynx  is  lymphoid  tissue  or  adenoids. 


PERSONAL  HYGIENE  213 

Signs  of  obstruction  are — open  mouth,  a  vacant,  unin- 
telligent expression,  snoring,  frequent  colds  and  nasal  dis- 
charge, mental  dullness,  deafness  and  cough. 

For  the  proper  development  of  the  chest  and  lungs  deep 
breathing  is  strongly  recommended. 

Stomach  and  Intestines. — The  first  great  rule  of  diges- 
tion is  not  to  eat  too  much.  The  simple  articles  of  diet 
are  the  best.  Temperance  in  the  use  of  alcoholic  drinks  is 
highly  recommended. 

The  intestines  should  be  emptied  every  day  or  two. 
Laxatives  may  be  necessary,  but  the  natural  means  are 
preferable.  These  consist  in  the  use  of  articles  of  diet 
which  have  a  coarse  residue  and  in  exercising  the  abdom- 
inal muscles.  Enemas  may  prove  a  useful  adjunct. 

Digestive  ferments  to  aid  digestion  are  not  recommended 
for  continuous  use.  Healthy  out-of-door  exercise  is  the 
best  appetizer. 

Hair  and  Nails. — Disease  germs  are  readily  harbored 
beneath  the  nails.  They  should  be  kept  short  and  cleaned 
daily  with  a  small  sharpened  piece  of  wood  which  is  to  be 
immediately  destroyed. 

The  hair  is  a  prolific  gatherer  of  germs.  It  should  be 
washed  at  least  once  a  week  and  the  scalp  rubbed  at  the 
same  time. 

Ringworm  and  lice  are  the  two  most  common  parasitic 
diseases  of  the  scalp  and  hair.  The  former  requires  treat- 
ment by  a  physician. 

To  remove  lice  cut  the  hair  short  and  apply  a  mixture 
of  equal  parts  of  olive  oil  and  kerosene  twice  a  day  for 
several  days. 

Hearing. — The  most  common  causes  of  defective  hearing 
are  adenoids,  wax  in  the  ears  and  inflammation  or  abscess 
in  the  middle  ear  from  inflammation  or  disease  of  the  nose 
or  throat.  Wax  and  adenoids  should  be  removed. 

Early  attention  to  diseased  throat  and  nose  conditions 
will  often  prevent  permanent  deafness. 

Eyes  and  Vision. — The  eye  conditions  requiring  atten- 
tion are  ophthalmia,  trachoma,  conjunctivitis,  and  func- 
tional diseases  from  eye-strain. 

Most  ophthalmias  occur  at  the  time  of  birth  and  can  be 
prevented  by  dropping  a  drop  of  1  per  cent,  solution  of 
silver  nitrate  into  the  eyes  of  the  new-born  child. 

Trachoma   is    a   contagious    disease    requiring   medical 


214  BATHS 

treatment.  It  can  be  avoided  by  avoiding  people  who  are 
suffering  from  it. 

Conjunctivitis  usually  occurs  from  over-strain  or  from 
dust  which  gets  into  the  eyes. 

Daily  use  of  a  %  per  cent,  solution  of  boracic  acid  will 
relieve  it. 

Eye-strain  can  be  avoided  by  avoiding  too  continuous 
eye  work,  fine  and  indistinct  work,  faulty  lighting  of  the 
room,  and  bad  posture  in  reading  or  writing. 

Nervous  system. — Hygiene  of  the  nervous  system  is  more 
or  less  complex.  It  consists  largely  of  avoiding  worry  and 
strain  and  maintaining  a  good  reserve  force  of  the  body. 
The  latter  is  accomplished  by  proper  food,  sufficient  sleep, 
exercise  and  daily  baths,  with  occasional  vacations. 

Cheerfulness,  happiness  and  avoidance  of  irritation  are 
great  aids  in  the  maintenance  of  a  healthy  nervous  system. 

Sleep  and  Rest. — The  amount  of  sleep  required  varies 
with  the  person  and  his  work.  The  child  usually  requires 
from  10  to  12  hours  of  sleep ;  the  young  adult  about  9 ; 
the  adult  of  middle  life  usually  finds  7  to  8  sufficient,  while 
old  people  can  usually  do  with  less. 

Sound,  refreshing  sleep  is  favored  by  a  well-ventilated 
room  (all  the  windows  should  be  open),  absolute  quiet, 
darkness  and  a  warm  bed. 

Baths. — Warm  baths  cleanse  the  skin  and  thus  promote 
its  healthy  functions.  They  may  be  taken  weekly,  bi- 
weekly, or  even  once  a  day — preferably  always  at  night. 
Warm  baths  have  a  temperature  of  85°  to  100°  F.  Hot 
baths  range  from  100°  to  110°  F.,  and  should  usually  be 
followed  by  cold  sponging  or  a  cold  shower. 

Cold  baths  are  not  cleansing,  but  have  a  stimulating  and 
tonic  effect  and  reduce  the  liability  to  catch  colds.  They 
should  be  taken  every  morning.  Cold  shower  baths  are 
more  invigorating  than  cold  tub  baths. 

Swimming  baths  provide  physical  exercise  and  promote 
health.  Salt  water  baths  are  usually  more  invigorating 
than  fresh  water  baths. 

Turkish,  Russian  and  hydro-therapeutic  douches  are  ad- 
mirable tonics — though  to  be  classed  as  luxuries. 

Baths  should  not  be  taken  too  soon  after  meals,  because 
digestion  may  be  lessened  or  entirely  stopped  by  the  blood 
being  called  from  the  stomach  to  the  skin  and  muscles. 
In  cold  baths  the  head  should  be  immersed  first  to  avoid 


TEMPERANCE  215 

increasing  the  blood  pressure  in  the  brain  too  greatly, 
which  might  result  if  the  body  were  gradually  immersed 
from  the  feet  upward. 

Clothing. — The  best  rules  for  clothing  are  those  which 
ordinary  intelligence  dictates.  Simple  general  rules  are  to 
keep  the  head  cool  and  the  extremities  warm;  avoid  tight 
constricting  bands;  and  wear  cool  clothing  in  summer  and 
warm  clothing  in  winter. 

For  summer  wear  the  light  colors  are  preferable,  and 
cotton  and  linen  fabrics  will  generally  be  found  the  coolest. 

For  winter  wear  wool,  silk  and  fur  are  the  warmest. 
Underclothes  of  wool  are  the  warmest  and  those  introduced 
by  Jaeger  are  the  most  comfortable  and  serviceable. 

The  much  condemned  corset  of  women's  wear  is  un- 
doubtedly harmful — if  for  no  other  reason  than  that  it 
interferes  with  free  respiration  as  well  as  exerting  pressure 
on  the  abdominal  viscera  and  producing  constipation. 

The  most  important  sanitary  precaution  to  preserve  in 
reference  to  clothing  is  that  of  cleanliness.  While  dark 
clothing  does  not  show  dirt  as  well  as  light  it  accumulates 
just  as  much,  and  should  be  cleaned  just  as  often.  The 
greatest  precautions  in  regard  to  cleanliness  are  required 
in  the  case  of  those  articles  of  clothing  worn  next  to  the 
skin. 

Exercise. —  (See  "Exercise  and  Recreation.") 

Temperance. — The  long-continued,  immoderate  use  of 
alcohol  leads  to  degenerative  changes,  primarily  in  the 
stomach  and  liver,  and  at  a  later  period  in  the  kidneys, 
lungs,  brain  and  blood  vessels.  The  degeneration  is  char- 
acterized by  increased  growth  of  interstitial  fibrous  tissue, 
which  in  course  of  time  shrinks  and  causes  atrophy  of 
gland  cells  and  loss  of  function.  Chronic  catarrh  and 
cirrhosis  of  the  stomach  with  cirrhosis  of  the  liver,  followed 
by  dropsy  and  hemorrhage,  are  the  well-recognized  results 
of  alcoholic  intemperance. 

The  effect  of  such  intemperance  in  shortening  life  is  now 
universally  recognized.  Statistics  bear  overwhelming  evi- 
dence on  this  point.  It  may  be  stated  generally  that  the 
mortality  of  the  intemperate  is  from  four  to  five  times 
greater  than  that  of  the  strictly  temperate  of  the  same 
age  and  in  the  same  class  of  life. 

All  evidence  points  to  the  fact  that  alcohol,  except  in 
strict  moderation,  is  injurious  to  men  who  are  exposed  to 


216  SEX  HYGIENE 

extremes  of  climate  (great  heat  and  great  cold),  or  who 
have  to  undergo  great  bodily  or  mental  labor.  Its  effect 
on  the  circulation  is  distinctly  injurious  to  those  engaged 
in  hard  bodily  work,  for  it  causes  the  heart  to  do  more 
work  without  conferring  any  counterbalancing  advantage. 

In  strictly  moderate  doses  alcohol  has  not  been  proved 
to  do  any  harm;  and,  taken  in  the  form  of  beer  or  wine, 
many  of  the  inhabitants  of  our  large  towns  find  it  a  useful 
aid  to  digestion  and  assimilation.  But  it  must  be  remem- 
bered that  there  are  idiosyncrasies  as  regards  alcohol,  and 
that  what  is  harmless  to  one  individual  may  be  injurious 
to  another.  For  thoroughly  healthy  people,  alcohol  in  any 
form  presents  no  advantages,  and  for  children  and  young 
people  it  is  decidedly  injurious. 

Worse  than  all  other  dangers  from  alcohol  is  the  danger 
of  the  alcohol  habit.  This  invariably  leads  to  loss  of  effi- 
ciency, dependence,  insanity  or  even  worse. 

Sex  Hygiene. — The  defective  or  degenerate  of  the  human 
race  should  not  be  allowed  to  propagate. 

To  produce  healthy  children  and  ones  not  prone  to  dis- 
ease, both  parents  should  possess  good  constitutions,  and 
they  should  take  great  care  not  to  weaken  these  by  excess 
of  any  kind,  physical  or  mental.  In  this  climate  the  proper 
age  for  marriage  is  considered  to  be  about  twenty-four  or 
twenty-five  for  the  man,  and  nineteen  or  twenty  for  the 
woman. 

A  disease  may  be  hereditary — as  syphilis — or  only  a  pre- 
disposition may  be  hereditary,  as  in  the  case  of  tuberculosis. 

Marriage  between  relatives  is  reprehensible — the  danger 
increasing  with  the  nearness  of  the  relationship. 

Before  a  marriage  is  contracted  it  should  be  a  certainty 
that  neither  party  is  suffering  from  syphilis  or  gonorrhea. 
Other  diseases  which  are  very  liable  to  reappear  in  the 
offspring,  especially  if  present  in  both  parents,  are  scrofula, 
gout,  hysteria,  epilepsy,  insanity,  some  physical  deformi- 
ties and  skin  diseases  and  criminal  tendencies  of  various 
kinds. 

Unhygienic  Habits. — There  are  certain  unhygienic  habits 
which  need  but  to  be  once  called  to  the  attention  to  be 
discontinued. 

Such  are  the  following : — 

Putting  articles  into  the  mouth — such  as  pencils,  coins, 


PILES  217 

candy,  chewing  gum  or  any  other  object  that  has  been  in 
the  mouth  of  another  person. 

Allowing  the  unwashed  fingers  to  touch  the  face,  eyes  or 
lips. 

Spitting,  or  coughing  and  sneezing  without  protecting 
the  mouth  with  a  handkerchief. 

Washing  the  teeth  in  a  wash  basin  which  is  used  by 
other  people  for  washing  purposes. 

Allowing  children  to  play  in  the  dirt. 

Careless  disposal  of  excreta. 

The  use  of  a  common  drinking  cup  and  the  drinking  of 
impure  water. 

Kissing  babies  on  the  mouth. 

Perspiration. —  (1)  Offensive  (sweating  feet).  The  feet 
of  dyspeptic  people  often  smell  offensively,  especially  if 
they  have  to  stand  a  great  deal.  In  these  persons  the  arm- 
pits also  are  apt  to  be  very  offensive.  The  digestion  must 
be  attended  to  first;  and  the  armpits  and  feet  are  to  be 
washed  daily  in  a  lotion  made  of  carbolic  acid  1  part  and 
water  39  parts.  After  drying  well,  dust  the  feet  with 
boric  acid  powder  and  starch,  equal  parts,  or  with  talc 
powder.  The  socks  or  stockings  are  to  be  wrung  out  of 
a  corrosive  sublimate  lotion,  1  in  2,000,  and  then  dried, 
before  being  worn.  And,  as  the  bacilli,  or  germs,  which 
cause  the  evil  smell,  flourish  in  the  damp  leather  of  boots, 
the  insides  of  the  boots  ought  to  be  wiped  out  with  a  wet 
rag  dipped  in  the  same  lotion,  occasionally. 

(2)  Excessive  sweating. — This  is  a  sign  of  general  de- 
bility, and  must  be  treated  with  tonics.  (See  "Night 
Sweats  of  Consumption.") 

Physiology. — This  is  the  science  which  deals  with  the 
duties  and  functions  of  all  the  parts  and  organs  of  the 
(human)  body,  when  it  is  in  a  state  of  health. 

Piles  (called  by  doctors,  "HEMORRHOIDS"). — Piles  are 
varicose  veins  of  the  rectum  or  lower  bowel.  It  is  usual 
to  speak  of  external  and  internal  piles.  An  internal  pile 
is  a  swollen  vein  in  the  inside  of  the  bowel,  just  inside  the 
anus;  and  an  external  pile  is  one  which,  perhaps,  was  once 
internal,  but  which  has  come  out  through  the  opening  dur- 
ing straining  at  the  water-closet,  and  which  has  been 
squeezed  and  bruised  by  the  muscle  which  closes  the  open- 
ing until  it  has  become  inflamed  and  bleeds.  External 


218  PILES 

piles  tend  to  get  well,  and  to  leave  behind  ridges  and  tags 
of  hard  skin  hanging  just  outside  the  anus. 

Causes. — A  sedentary  life,  constipation,  sluggish  liver, 
overeating,  alcoholic  disease  of  stomach  or  liver,  pregnancy. 

Signs. — A  person  may  have  external  piles  for  years  with- 
out caring  anything  about  them,  though  suffering  much 
discomfort  when  the  bowels  are  costive.  But  when  they 
get  inflamed,  there  is  a  feeling  of  weight  and  great  soreness 
at  the  anus,  pain  during  the  passage  of  motions,  itching 
and  throbbing,  and  perhaps  irritability  of  the  bladder  and 
a  frequent  desire  to  pass  water.  When  piles  get  really 
inflamed  and  swollen  the  patient  cannot  even  sit  down  in 
comfort.  Then  the  piles  will  suppurate  and  discharge  pus. 
This  process  is  often  Nature's  way  of  bringing  about  a 
cure ;  the  piles  get  filled  up  with  blood  clot  and  shrivel  up. 

Internal  piles  show  their  presence  by  bleeding,  which,  if 
copious  and  too  frequent,  may  be  a  danger  to  health.  But, 
generally,  the  loss  of  an  ounce  or  two  of  blood  by  piles  is  a 
good  thing  for  the  patient,  and  may  save  him  headaches, 
apoplectic  strokes  and  attacks  of  illness. 

Treatment. — (1)  Palliative. — A  spare  diet,  especially 
avoiding  alcoholic  drinks,  much  meat,  and  spiced  foods. 
The  bowels  must  be  kept  always  a  little  loose,  not  with 
strong  purges,  but  with  gentle  laxatives  like  magnesia,  con- 
fection of  senna,  brimstone  and  treacle,  castor  oil,  phenol 
phthalein  tablets,  licorice  powder — and  not  calomel,  aloes, 
colocynth,  jalap. 

When  piles  are  acutely  inflamed. — Take  two  grains  of 
calomel  at  bedtime  and  a  dose  of  castor  oil  (half-an-ounce) 
in  the  morning.  Take  hot  hip  baths  or  use  hot  fomenta- 
tions. If  an  external  pile,  with  a  blood  clot  inside,  is  in- 
flamed and  tender,  send  for  a  doctor,  who  will  probably 
puncture  it. 

If  you  have  internal  piles,  especially  bleeding  ones,  which 
come  out  every  time  you  go  to  the  closet,  you  must  gently 
press  them  back  again,  and  use  a  collapsube  of  ointment 
of  galls  and  opium,  or  of  hamamelis  and  cocaine,  or  of 
ferric  perchloride.  Regular  exercise  is  essential  in  all 
these  cases.  Conium  ointment  is  also  an  excellent  soothing 
application. 

(2)  Operative. — The  operations  for  piles  are  called  " ex- 
cision" and  "ligature."  Of  course,  they  are  entirely  out- 
side the  province  of  home-doctoring.  But  it  is  quite 


PLEURISY  219 

certain  that  many  a  man  and  woman  whose  piles  are  a 
lifelong  nuisance  to  them  would  be  immensely  relieved 
by  the  simple  and  safe  operation  for  the  removal  of  their 
piles.  Such  an  operation  would  lay  a  patient  up  only  for 
about  a  week  and  the  relief  would  be  immediate. 

Pleurisy. — This  is  an  inflammatory  disease  within  the 
chest.  It  is  accompanied  by  fever  in  the  acute  form,  but 
may  become  chronic,  and  may  last  for  weeks  without  any 
fever  being  present.  It  is  an  inflammation  of  the  pleura, 
or  serous  membrane,  which  lines  the  inside  of  the  chest, 
and  also  covers  the  surface  of  the  lungs,  so  that  the  two 
surfaces  of  the  membrane  glide  over  each  other  with  every 
breath  that  is  taken.  These  movements  are  quite  unfelt  in 
a  state  of  health,  but  when  pleurisy  has  come  on  each 
breath  taken  and  every  movement  of  the  chest  causes  pain, 
which  in  acute  inflammation  may  be  of  a  very  acute  nature. 
In  health  the  pleural  surfaces  are  smooth  and  moist,  but 
when  inflamed  there  is  at  first  dryness,  then  roughness  and 
tenderness.  After  some  hours  of  the  disease  a  change  oc- 
curs and  some  fluid  is  poured  out,  and  some  flaky,  white, 
solid  material  is  deposited.  The  fluid  which  is  formed  col- 
lects in  the  chest  cavity  around  the  lung,  and  if  the  quan- 
tity becomes  great  it  compresses  the  lung  more  and  more 
and  renders  it  unable  to  expand.  At  first  this  pleuric  ef- 
fusion is  a  clear,  pale  yellow,  watery  liquid,  but  if  the 
inflammation  continues  the  clear  effusion  becomes  opaque 
and  purulent,  like  the  contents  of  a  boil  or  an  abscess. 
This  is  called  by  doctors  empyema.  This  is  a  very  serious 
state  of  disease  and  very  often  leads  to  early  death. 
Pleurisy  is  generally  set  up  by  catching  cold  from  exposure 
to  cold  and  damp;  in  healthy  persons  attacks  are  usually 
short  and  easily  cured,  but  if  pleurisy  attacks  a  consump- 
tive child  or  young  person  it  is  always  a  serious  matter. 
On  the  other  hand,  in  a  person  who  has  consumption  of 
the  lungs,  local  pleurisy  is  one  of  Nature's  methods  of  try- 
ing to  localize  and  heal  the  mischief. 

An  attack  of  pleurisy  begins  with  a  feeling  of  chilliness 
and  a  shivering  fit,  followed  by  flushes  of  heat  and  thirst, 
headache  and  a  burning  skin ;  there  is  acute  pain  somewhere 
in  the  chest,  most  often  in  the  side,  and  a  dry  cough,  which 
much  increases  the  pain.  Either  one  or  both  sides  may  be 
affected.  The  pulse  is  hard  and  quick,  and  the  breathing 
is  rapid ;  there  is  restlessness,  and  a  feeling  of  anxiety,  and 


220  PNEUMONIA 

the  urine  is  scanty  and  high  colored.  As  soon  as  these 
symptoms  are  observed,  the  patient  must  give  up  and  go 
to  bed,  have  a  hot  bath,  and  then  lie  between  blankets, 
take  a  sharp  purgative,  and  put  a  hot  linseed  jacket 
poultice,  with  a  little  mustard,  on  the  painful  part  of  the 
chest.  A  doctor  must  take  charge  of  the  case  at  once. 
(See  "Poultices.") 

Pneumonia. —  (See  also  "Lung  Diseases.") — Men,  women 
and  children  are  all  liable  to  pneumonia,  in  which  the  chief 
trouble  is  inflammation  of  the  lungs.  The  persons  who 
run  most  risk  of  it,  and  who  are  most  liable  to  die  of  it, 
are  drunkards.  It  is  slightly  contagious.  The  disease  be- 
gins quite  suddenly:  the  patient  has  a  shivering  fit,  his 
temperature  runs  up  to  103°  or  104°  (the  usual  healthy 
temperature  is  98% °  and  anything  higher  than  that  is 
called  "fever")  ;  his  tongue  is  coated,  his  appetite  is  lost, 
and  he  has  a  bad  headache  and  shivering.  Then  he  coughs 
in  a  painful  way,  and  spits  up  phlegm  tinged  with  blood. 
In  a  few  hours  more,  he  is  propped  up  in  bed  with  flushed 
forehead  and  cheeks,  bright  eyes,  and  panting,  gasping  for 
breath.  He  is  very  feverish,  and  his  skin  is  dry.  At  night 
he  cannot  sleep,  but  wanders  in  his  mind  and  talks  non- 
sense. He  gets  worse  and  worse  (and  perhaps  dies). 

But  suddenly,  when  he  has  been  ill  about  eight  days, 
and  is  very  bad  indeed,  he  falls  asleep ;  his  fever  abates, 
his  pulse  rate  goes  down,  his  breathing  becomes  easy,  his 
dry,  brown  tongue  grows  moist — and  he  wakes  up  feeling 
almost  well !  From  that  time  forward  he  slowly  but  surely 
improves  until  he  is  all  right  again.  Nearly  all  the  cases 
of  pneumonia  that  recover  end  in  this  way. 

Here,  then,  is  a  disease  which  is  caused  by  a  germ,  which 
runs  its  course,  and  which  cannot  be  cut  short.  It  is  a 
dangerous  disease  and  its  treatment  demands  much  skill. 

No  sensible  person  without  a  medical  training  would  care 
to  undertake  the  treatment  of  pneumonia  on  his  own  re- 
sponsibility. The  doctor  will  order  a  diet  of  milk,  beef 
tea  or  mutton  broth  given  in  small  quantities,  frequently; 
and  the  patient  may  have  a  liberal  amount  of  water  to 
drink.  Large  hot  linseed-meal  poultices  may  be  wanted 
(see  "Poultices").  Leeches  may  be  required.  An  ice  bag 
(a  gutta-percha  bag  to  hold  fragments  of  ice)  may  be  called 
for.  Alcoholic  stimulants  may  be  the  only  thing  which 
will  keep  life  in  the  patient  in  the  later  stage  before  the 


POISONING  221 

crisis — as  much  as  8  to  12  or  more  ounces  of  good  whisky 
or  brandy  daily  may  have  to  be  taken.  (See  "Drachms" 
and  "Ounces.")  The  sleeplessness  requires  special  treat- 
ment; the  ice  bag  to  the  head  is  recommended  by  many 
doctors,  but  chloral  must  not  be  given  even  if  the  patient 
is  accustomed  to  its  use. 

In  recent  years  great  emphasis  has  been  laid  upon  the 
importance  of  fresh  air  in  the  treatment  of  pneumonia. 
Many  cases  are  treated  out  of  doors.  Oxygen  is  freely 
given  in  many  cases.  Serums  seem  to  be  of  assistance  in 
some  cases,  but  no  specific  has  yet  been  discovered.  The 
chief  danger  in  pneumonia  is  heart  failure  during  the  at- 
tack and  thrombosis  and  embolism,  causing  instant  death, 
during  convalescence.  Therefore  a  patient  must  be  kept 
absolutely  quiet  until  all  danger  is  past. 

During  convalescence  a  tonic  will  be  required,  followed 
later,  if  possible,  by  a  change  of  air  to  a  temperate  sunny 
climate  for  a  few  weeks. 

Prevention, — As  pneumonia  is  an  exceedingly  common 
disease  during  winter  and  spring  and  as  it  so  often  results 
fatally,  it  is  important  that  all  possible  care  be  taken  to 
avoid  contracting  the  disease.  This  is  done  first  by  in- 
creasing the  body  resistance,  and  second  by  avoiding  con- 
tact with  the  infectious  cause,  or  pneumococcus  germ. 

The  body  resistance  is  maintained  by  the  following 
means : 

Exercise,  cold  morning  bath,  good  nourishment,  little 
worry,  little  alcohol  to  drink  and  little  tobacco  smoking. 

Avoidance  of  exposure  to  cold,  draught,  sudden  changes 
of  temperature  and  wet  feet. 

Pneumococcus  vaccine  will  increase  the  body  resistance 
to  infection. 

The  infective  agent  is  avoided  by  careful  household 
cleaning,  avoiding  close  proximity  to  people  who  are  cough- 
ing, sneezing,  or  spitting  in  public  places,  or  breathing 
through  the  nose  while  in  their  presence.  Frequent  careful 
cleaning  of  the  mouth  with  antiseptic  solution — especially 
in  the  morning,  evening  and  after  meals. 

Poisoning. — When  a  person  has  taken  poison  you  must 
send  for  the  doctor  at  once.  In  the  meantime,  if  you  know 
what  poison  he  has  taken,  you  may  be  able  to  save  him; 
if  you  do  not  know,  you  must  await  the  doctor,  but  in  the 
meanwhile  you  need  not  be  idle. 


222  POISONING 

FIRST  CASE. — You  know  what  poison  has  been  taken.  If 
it  is  Prussic  Acid  or  Cyanide  of  Potash  the  patient  will 
almost  certainly  die  at  once.  There  is  no  time  to  save  him. 
But  if  he  is  not  yet  dead,  and  lies  insensible,  pale,  and 
rigid : — 

(1)  Give  him  a  tablespoonful  of  mustard  in  a  tumbler- 

ful of  warm  water.     If  he  vomits,  it  is  well;  if 
not,  put  your  finger  to  the  back  of  his  throat. 

(2)  When  he  has  been  sick,  give  him  brandy  or  strong 

beef  tea  or  strong  coffee. 

(3)  Pour  cold  water  over  his  head,  holding  him  over  a 

basin. 

These  two  poisons  are  very  powerful.  They  are  used  in 
photography  and  are  too  easily  obtained. 

If  the  poison  is  Laudanum,  the  patient  is  first  excited, 
then  depressed,  then  insensible.  At  first  you  can  rouse 
him,  afterwards  he  becomes  like  one  dead,  with  noisy 
breathing,  blue  lips,  and  pale,  ghastly  face. 

(1)  Give  him  a  tablespoonful  of  mustard  in  a  tumbler- 

ful of  water. 

(2)  March  him  about,  stimulate  him,  douche  him,  keep 

him  alive  by  worrying  him  in  every  way.     If 
you  let  him  alone  he  will  die,  probably. 

(3)  Give  him  a  pint  of  very  hot  strong  black  coffee, 

injected  into  the  rectum,  or  back  passage,  with 
a  glass  or  Higginson  syringe. 

If  the  poison  is  Oxalic  Acid,  make  him  swallow  chalk, 
lime  or  whiting,  or  plaster  scraped  from  the  wall,  in  large 
quantities,  washed  down  with  water.  Don't  give  an  emetic. 
Give  him  stimulants  and  castor  oil.  But  the  acid  is  irritant 
and  you  cannot  do  much  for  a  person  whose  whole  mouth 
and  food  tube  are  inflamed  and  corroded. 

If  the  poison  is  White  Arsenic,  there  will  be  very  little 
time.  Give  spoonful  of  magnesia  and  white  of  egg  and 
salad  oil  until  the  doctor  comes. 

If  the  poison  is  Carbolic  Acid,  give  him : — 

(1)  A  tablespoonful  of  mustard  in  a  tumblerful  of 
warm  water. 


POLYPUS  223 

(2)  When  he  has  been  sick,  give  him  half-an-ounce  of 

Epsom  salts  in  a  half -pint  of  cold  water. 

(3)  Keep  him  warm,  and  give  him  stimulants. 

Sometimes  people  take  overdoses  of  sleeping  draughts. 
For  an  overdose  of  Chloral: — 

(1)  Make  him  sick  by  tickling  the  back  of  the  throat. 

(2)  Rouse   him,    stimulate   him,    flick  him   with  wet 

towels,  force  him  to  walk  about,  worry  him. 

(3)  Inject  a  pint  of  hot  coffee  into  the  rectum. 

SECOND  CASE. — You  do  not  know  what  poison  has  been 
taken.  In  this  case  you  must  use  your  wits  and  notice 
what  symptoms  he  has. 

If  he  has  Vomiting,  Diarrhea,  and  Colic — he  may  have 
taken  sugar  of  lead,  phosphorus,  arsenic,  spirits  of  salts, 
corrosive  sublimate,  sulphuric  acid,  Prussian  blue,  salts  of 
sorrel,  or  other  irritant  poison. 

(1)  Do  NOT  give  an  emetic,  because  you  may  injure 

stomach  by  the  vomiting. 

(2)  Give  plenty  of  lime  water,  or  milk,  or  magnesia, 

or  wall-plaster,  or  whitewash,  or  whiting,  or 
chalk,  and  plenty  of  milk  and  water  to  wash 
them  down.  If  he  vomits  them  up,  give  him 
more. 

(3)  When  he  becomes  exhausted,  give  a  tablespoonful 

of  brandy  or  whisky  in  milk  or  water,  and  put 
hot-water  bottle  to  his  feet,  until  the  doctor 
comes. 

Smell  his  breath.  If  he  has  taken  carbolic  acid  or  prussic 
acid  or  laudanum  or  alcohol,  you  will  know  it  by  the  smell. 
Phosphorus  (rat  paste)  smells  of  garlic.  If  he  is  quite 
insensible,  he  may  have  taken  opium,  morphine,  bella- 
donna, laudanum,  chloral,  chloroform ;  or  he  may  be  suffer- 
ing from  coal  gas  which  has  escaped  into  the  room  where 
he  slept.  In  all  these  cases  stimulation  of  every  kind  is 
desirable,  though  no  special  treatment  can  be  undertaken 
without  medical  advice. 

Polypus. — This  is  an  old-fashioned  Latin  word,  used  to 
mean  a  little  tumor  (or  swelling)  with  a  stalk,  short  or 


224  POLYPUS  IN  THE  EAR 

long,  by  which  it  is  attached  to  the  mucous  membrane 
somewhere — in  the  nose,  the  throat,  the  ear,  the  rectum  or 
the  womb.  It  is  impossible  to  understand  what  a  polypus 
really  is  without  knowing  what  a  mucous  membrane  is,  and 
so  you  must  first  read  the  article  on  *  *  Mucous  Membrane. ' ' 
Now,  when  a  mucous  membrane  is  afflicted  with  catarrh 
and  inflammation  (see  "Abscess")  for  a  long  period,  dur- 
ing which  pus,  or  matter,  is  always  trickling  over  it,  the 
membrane  gets  into  an  irritable  state  and  a  polypus  is 
formed,  which  tends  to  drop  off  by  its  own  weight,  but  may 
remain  attached  by  a  stalk. 

A  nasal  polypus  is  a  red,  soft,  gelatinous,  mucous  tumor, 
like  a  hanging  pear-drop.  If  it  gets  big  enough  it  blocks 
up  the  nostril,  and  then  it  must  be  removed  by  a  surgeon. 
He  passes  a  silver  wire  noose  over  it  and  twists  it  off.  If  the 
catarrh  continues,  of  course,  there  may  be  another  there 
very  soon,  growing  on  to  the  stalk  of  the  old  one.  A  nasal 
polypus  generally  causes  deafness. 

Polypus  in  the  ear  is  often  one  of  the  results  of  years 
of  the  very  common  middle-ear  disease,  with  its  chronic 
discharge.  It  must  be  removed,  by  an  aural  surgeon,  with 
a  "snare." 

These  fibroid  tumors,  and  fibroid  polypi  of  the  womb, 
are  very  common  among  women  in  the  middle  period  of 
life — so  common  that  they  are  the  real  reason  for  the  un- 
fortunate stoutness  of  so  many  middle-aged  women.  When 
a  woman  has  dull,  aching,  throbbing  pain  in  the  abdomen, 
with  feelings  of  weight  and  * '  bearing  down, ' '  piles,  costive- 
ness,  and  frequent  attacks  of  bleeding,  she  very  likely  has, 
in  her  womb,  a  fibroid  tumor,  which  may  or  may  not  have 
become  a  polypus  already.  By  that  time  the  surgeon  will 
be  able  to  feel  the  tumor  and  will  advise  as  to  its  removal. 
Short  of  operation,  the  patient  may  control  bleeding  by 
douches  of  hot  water,  and  by  taking  this  medicine  in- 
ternally:— Ammonia  sulphate  of  iron,  30-36  grains;  dis- 
tilled water,  8  ounces;  mix.  Take  a  sixth  part  every  six 
hours.  Very  hot  water  douches  will  generally  stop  the 
bleeding,  and  give  a  sense  of  great  comfort.  But,  if  very 
profuse,  a  solution  of  hemisine,  or  adrenalin,  or  supra- 
renalin  (liquid  extract,  1  part,  hot  water,  10  parts)  will 
be  necessary  to  check  the  hemorrhage.  These  three  drugs, 
which  closely  resemble  each  other,  are  the  very  latest  and 


POULTICES  225 

best  agents  for  checking  every  kind  of  bleeding.  Cheaper 
drugs  for  the  same  purpose  are — turpentine,  perchloride 
or  iron  and  alum. 

The  reader  will  now  understand  that  when  a  patient 
says  that  he  or  she  has  "a  polypus,"  and  wants  a  "cure" 
for  it,  we  can  give  no  help.  A  polypus  may  occur  any- 
where where  there  is  a  mucous  membrane,  and  its  only 
treatment  is  local,  and  requires  skill. 

Polypus  of  the  Womb. — The  commonest  sort  of  tumor 
of  the  womb  is  a  little  hard,  fibrous  knob,  which  grows  and 
develops  witjiin  the  substance  of  the  womb  itself.  Most  of 
our  readers  know  that  the  womb  is  the  muscular  bag  in 
which  the  unborn  child  lives  and  develops  until  it  is  ready 
to  be  born.  The  little  knob,  growing  in  the  muscular 
substance  (the  "flesh")  of  the  womb  is  gradually  squeezed 
out  of  it,  and  bulges  either  into  the  hollow  inside  of  the 
womb,  or  on  the  outside,  among  the  coils  of  gut.  In  either 
case,  it  drags  the  mucous  membrane  along  with  it  and 
when  it  is  squeezed  right  out  of  the  womb  substance,  it 
remains  hanging  as  a  tumor  with  a  stalk  of  mucous  mem- 
brane, either  inside  or  outside  the  womb.  The  tumors, 
which  happen  to  be  squeezed  outside,  and  lie  among  the 
coils  of  intestine,  are  not  very  dangerous,  however  large 
they  may  grow;  but  those  inside  the  womb  (called  polypi) 
cause  much  pain  and  bleeding,  and  may  have  to  be  re- 
moved by  operation. 

Poultices  are  rather  old-fashioned  applications  for  ap- 
plying heat  and  moisture  to  inflamed  parts.  They  are  not 
so  cleanly  as  fomentations,  and  ought  not  to  be  used  for 
sores  or  anywhere  where  the  skin  is  broken,  because  they 
are  not  antiseptic  and  may  even  themselves  contain  the 
germs  of  disease. 

A  poultice  must  only  just  be  big  enough  to  cover  the 
inflamed  part;  if  it  is  bigger  it  makes  the  surrounding 
parts  sodden  and  helps  to  spread  the  inflammation.  When 
an  abscess  has  discharged  itself  no  more  poultices  must  be 
used;  their  time  of  usefulness  is  over.  Before  applying 
a  poultice  to  the  chest  of  a  young  child  or  old  person  a 
piece  of  warm  flannel  must  be  placed  there  first,  and  grad- 
ually withdrawn  after  the  hot  poultice  is  in  its  place. 
Thus  the  great  heat  of  the  poultice  is  brought  gradually 
and  not  suddenly  to  the  child's  notice.  This  is  a  little 


226  TO  MAKE  A  POULTICE 

nursing  "tip"  which  few  trained  nurses  know.  After  re- 
moving a  poultice,  dry  the  skin  and  cover  it  with  a  layer  of 
cotton  wool. 

To  make  a  poultice. — Have  everything  quite  ready  before 
beginning  to  make  it,  so  that  when  it  is  made  it  may  be  ap- 
plied without  delay,  as  hot  as  possible ;  test  its  heat  by  apply- 
ing it  first  to  your  own  cheek.  A  linseed  poultice  is  thus 
made.  ' '  Into  a  basin,  previously  scalded,  place  the  ground 
linseed  meal,  enough  for  the  size  of  poultice  required.  Pour 
scalding  water  on  it  gradually,  stirring  with  a  table  knife 
or  ivory  paper  knife.  Spread  the  poultice  on  linen,  old 
flannel,  or  tow;  the  tow  is  then  folded  over  the  edge  of  the 
meal  and  the  poultice  is  ready.  It  is  a  better  plan  to  pour 
the  water  on  the  meal  than  to  sprinkle  the  meal  on  the 
water,  unless  a  very  large  poultice  is  required.  A  bread 
poultice  is  thus  made: — Stale  white  bread  crumbs  are 
dropped  into  boiling  water  and  the  cup  in  which  the  poul- 
tice is  being  made  is  then  covered  with  a  saucer  and  stood 
upon  the  hob.  The  water  is  then  drained  away  and  the 
pulp  applied  upon  a  piece  of  linen.  A  starch  poultice  is 
soothing  and  retains  the  heat  a  long  time,  and  is  suitable 
for  inflamed  skin  eruptions.  The  starch  is  first  mixed 
with  cold  water  and  then  boiling  water  is  added  until  the 
mess  becomes  of  a  proper  consistence.  A  charcoal  poultice 
is  a  good  antiseptic  one.  Finely-powdered  vegetable  char- 
coal is  mixed  with  bread  or  linseed  meal  and  a  little  more 
charcoal  is  sprinkled  over  the  surface  just  before  apply- 
ing it.  A  mustard  poultice  is  thus  made: — The  mustard 
powder  is  made  into  a  thin  paste  with  hot  or  tepid  water 
and  spread  in  a  thin  layer  on  brown  paper,  and  covered 
over  with  a  layer  of  muslin.  It  is  kept  on  as  long  as 
necessary,  or  as  long  as  it  can  be  borne,  say  fifteen  minutes, 
unless  blistering  of  the  skin  is  aimed  at.  An  eau-de- 
cologne  poultice  consists  of  an  ordinary  pocket  handker- 
chief saturated  with  eau-de-cologne,  and  applied  to  the 
skin  with  a  layer  of  oil  silk  over  it.  This  is  quite  enough 
to  produce  the  redness  of  counterirritation  on  some  skins 
and  the  redness  quickly  disappears." 

A  hot  boiled  Spanish  onion  is  a  splendid  poultice  for 
earache,  as  its  pointed  end  fits  into  the  ear,  keeps  the 
heat  a  long  time,  and  the  juice  is  an  antiseptic.  Put  a 
large  pad  of  cotton  wool  over  it  and  bandage  on  it.  (See 
also  * '  Fomentations. ' ' 


PREGNANCY,  SIGNS  OF  227 

Pregnancy,  Hygiene  of. — Pregnant  women  must  have 
plenty  of  fresh  air  and  only  moderate  exercise.  Walking 
is  better  than  riding.  All  fatigue  to  be  avoided,  also 
crowded  entertainments.  Dress. — Tight  stays,  garters  and 
collars  are  not  to  be  worn.  If  the  enlargement  of  the 
abdomen  is  excessive,  an  obstetric  belt  must  be  worn. 
Flannel  drawers  are  advisable. 

The  bowels  must  be  kept  well  open,  with  cascara  or  saline 
purges  if  necessary.  A  warm  bath  ought  to  be  taken 
once  weekly.  If  the  breasts  are  painful  they  must  be 
bandaged  or  supported;  the  nipples  must  be  hardened  by 
bathing  with  equal  parts  of  whisky  and  water,  or  alum 
lotion,  night  and  morning.  The  nipples,  if  not  prominent, 
must  be  drawn  out  and  kept  out  for  a  few  minutes  daily 
by  an  elastic  .ring  placed  round  the  bases  of  them.  This 
is  most  important,  as  also  is  this — that  in  every  pregnant 
woman  the  urine  ought  to  be  analyzed  at  least  twice  during 
the  carrying  of  the  child. 

Lastly,  at  the  periods  which  correspond  to  the  courses 
which  would  otherwise  be  in  progress,  great  care  and 
caution  is  to  be  observed,  as  miscarriage  is  more  apt  to 
occur  then. 

Pregnancy,  Signs  of. — Wives  are  frequently  doubtful  as 
to  whether  they  are  ' '  in  the  family  way ' '  or  not.  In  many 
cases  the  skill  and  experience  of  a  medical  man  are  neces- 
sary to  decide  the  question,  but  very  often  there  is  no 
difficulty  in  being  sure,  one  way  or  the  other,  at  an  early 
date.  The  ordinary  signs  of  the  pregnant  condition  are 
here  given,  with  comments: — 

(1)  A  woman,  on  becoming  pregnant,  at  once  ceases 
her  menstrual  periods  (see  "Menstruation").  This  is  the 
first  sign,  and  is  relied  upon  by  most  women  for  calculat- 
ing when  the  baby  will  be  born.  Precise  calculation  is 
impossible,  as  a  rule,  but  the  confinement  may  be  expected 
about  280  days  from  the  first  day  of  the  last  menstrual 
period. 

Fallacies. — But  the  periods  may  cease,  in  any  girl  or 
woman,  because  of  anaemia,  which  must  be  treated  by  a 
doctor.  And,  very  often  the  fear  of  becoming  pregnant 
may  cause  the  periods  to  cease  for  some  weeks,  and  the 
desire  to  become  pregnant  may  stop  them.  In  fact,  any 
nervous  condition  is  enough  to  upset  some  women  in  this 
way.  Secondly,  a  woman  may  continue  to  menstruate  for 


228  PSOEIASIS 

three  or  four  months,  even  though  she  is  pregnant,  be- 
cause of  a  polypus  or  other  disease  of  the  womb. 

(2)  The  breasts  of  a  woman  feel  full  and  hard  at  a 
very  early  stage  of  pregnancy. 

(3)  In  the  second  month   comes   "morning  sickness." 
The  expectant  mother  feels  sick  on  getting  up  in  the  morn- 
ing.    This  is  a  very  common  sign,  but  is  occasionally  quite 
absent.     Sometimes,  however,  the  vomiting  is  a  very  serious 
matter.     Fallacy. — Women  who  drink  overnight,  or  who 
tipple  in  secret,  are  often  sick  in  the  morning  from  catarrh 
of  the  stomach. 

(4)  After  the  third  month  the  dark  circles  round  the 
nipples  of  the  breast  become  very  dark  red  instead  of  a 
rosy  pink,  and  a  drop  of  milk  may  sometimes  be  squeezed 
out  of  the  breast.     But  many  blonde  women  show  no  sign 
of  this  kind. 

All  the  other  signs  are  such  as  only  a  doctor  can  under- 
stand or  seek  for. 

Psoriasis. — This  has  been  called  "the  skin  disease  of  the 
healthy  man,"  and  it  is  true  that  most  of  those  who  have 
this  disease  are  otherwise  quite  healthy.  Psoriasis  con- 
sists in  a  chronic  inflammation  of  the  skin,  with  raised 
red  patches,  covered  with  silvery  or  yellowish-white  dry 
scales.  No  one  knows  the  true  cause  of  psoriasis. 

Psoriasis  often  appears  first  in  childhood  and  then  goes 
away  again,  and  reappears  occasionally.  It  occurs  espe- 
cially in  gouty,  rheumatic,  and  syphilitic  families,  and  is 
particularly  noticeable  in  the  spring  of  each  year.  It  is 
not  infectious  or  contagious.  The  true  psoriasis  has  silvery 
scales,  and  when  it  occurs  in  a  person  who  has  had  syphilis 
the  scales  are  much  yellower.  It  can  hardly  be  said,  how- 
ever, that  syphilis  has  much  to  do  with  the  causation  of 
the  disease. 

Psoriasis  first  appears  on  the  back  of  the  forearms  and 
•elbows,  and  on  the  front  of  the  knees.  There  are,  in 
the  earliest  stage,  small  pimples  each  capped  with  a  little 
dry  scale,  and  the  pimples  grow  or  unite  with  others  until 
they  form  patches  of  two  or  three  inches  wide.  Then 
other  parts  of  the  body  become  affected.  There  is  no  pain 
or  itching. 

Treatment. — Of  course,  the  first  thing  to  do  is  to  guess 
at  the  probable  cause  of  the  disease  and  to  deal  with  any 
rheumatic  or  gouty  taint  that  the  person  may  have,  A£ 


PSORIASIS  229 

to  diet,  it  is  of  very  little  real  service,  as  a  rule,  to  adopt 
any  special  diet.  But  the  writer  has  seen  cases  in  which 
a  month  or  two's  severely  vegetarian  diet  worked  wonders 
in  the  cure  for  psoriasis. 

The  one  medicine  of  all  others  which  seeme  to  have  in  all 
cases  a  certain  amount  of  beneficial  effect,  is  arsenic.  But 
arsenic,  though  a  valuable  medicine  in  the  hands  of  a  medi- 
cal man,  is  yet  a  very  powerful  poison.  The  dose  of  it  is 
to  be  increased  right  up  to  the  limit  of  toleration  of  the 
patient;  until,  in  fact,  he  gets  redness  round  the  eyes. 
Then  it  is  to  be  continued  until  the  eruption  has  disap- 
peared, and  for  three  months  after  that,  in  gradually 
diminishing  doses.  But  at  the  very  beginning  of  a  first 
attack  of  psoriasis  arsenic  is  not  to  be  given ;  in  that  stage, 
thyroid  extract  tablets  may  be  given  with  advantage. 

Psoriasis,  then,  is  a  disease  which  is  not  suitable  in  any 
way  for  amateur  treatment.  Both  arsenic  and  thyroid  are 
powerful  medicines  and  require  a  doctor's  prescription. 
A  celebrated  physician  recommends  the  patient  with 
psoriasis  to  swallow  a  10-minim  capsule  of  turpentine 
three  times  a  day;  and  he  increases  the  dose  up  to  30- 
minim  doses. 

Local  treatment. — This  is  much  more  important  and  more 
easily  manageable  at  home  than  the  constitutional  treat- 
ment. The  best  application  of  all  is  chrysarobin  ointment, 
which  must  be  rubbed  well  into  the  patches  of  the  disease 
but  must  not  be  allowed  to  touch  the  healthy  skin  round 
about.  The  strength  of  the  ointment  may  be,  say,  15 
grains  to  an  ounce  of  vaseline.  The  ointment  stains  the 
skin  and  bedclothes,  and  if  applied  to  the  face  may  make 
the  eyelids  dropsical.  But  if  it  is  rubbed  into  patches  on 
the  body,  some  of  it  gets  absorbed  and  does  good  at  last 
to  the  patches  on  the  face. 

In  dealing  with  a  patch  of  psoriasis  it  is  of  no  use  to 
rub  any  ointment  on  it  until  you  have  rubbed  off  the 
scales.  Tar  ointment  is  not  so  messy  as  chrysarobin,  and 
the  detergent  tar  solution  may  be  thought  even  more  con- 
venient. This  solution  acts  well  if  applied  to  the  patches 
undiluted  and  allowed  to  dry  on. 

Hutchinson's  excellent  ointment  for  psoriasis  is  as  fol- 
lows:— White  precipitate,  10  grains;  chrysarobin,  10 
grains;  creosote,  20  minims;  detergent  solution  of  tar,  10 
minims;  benzoated  lard,  1  ounce  (mix). 


230  PURGATIVES 

If  a  patient  finds  it  difficult  to  get  off  the  scaliness,  let 
him  apply  to  the  patches  for  several  hours,  pads  of  lint 
soaked  in  weak  carbonate  of  soda  solution  and  bandaged 
on  over  a  piece  of  oiled  silk. 

Purgatives. — Medicines  which  act  upon  the  bowels.  The 
following  list  of  purges  will  be  found  to  contain  some- 
thing in  the  way  of  medicine  suitable  for  the  relief  of  all 
kinds  of  costiveness,  sluggish  liver,  congestive  headaches, 
dropsy  and  blood  poisoning.  (See  also  "Dosage.") 

(1)  Laxatives. — Medicines     which     cause     Very     gentle 
purging,   without  griping,    and   with   soft   semi-fluid  mo- 
tions:— Honey,    figs     (especially    green    figs),    tamarinds, 
prunes,  brimstone  and  treacle,  citrate  of  magnesia. 

(2)  Aperients  produce  more  liquid  motions  and  cause  a 
little  griping: — Black  draught  (compound  senna  draught), 
white  mixture  (at  all  hospitals),  extract  of  cascara  sagrada 
(adult  dose,  2  to  4  grains),  castor  oil  (adult  dose,  1  fluid 
ounce). 

(3)  Saline  purgatives  are  especially  good  for  gouty  and 
rheumatic  people,  and  those  with  Bright 's  disease,  or  liver 
disease,  or  who  suffer  from  headaches    (see  also  "Head- 
ache") : — Phosphate   of  soda    (dose,   2   drachms),   Epsom 
salts  (y±.to  1/2  an  ounce),  Seidlitz  powders,  cream  of  tar- 
tar (1  to  3  drachms). 

(4)  Cholagogues  especially  stimulate  the  liver  and  move 
the  bowels: — Blue  pill,  calomel,  podophyllin.     (Require  a 
medical  man's  prescription.) 

(5)  Drastic  purgatives  cause  a  violent  and  very  watery 
action  of  the  bowels.     They  are  required  in  cases  of  drunk- 
enness, dropsy    (unless  the  heart  is  feeble)  : — Colocynth, 
jalap  (compound  jalap  powder,  1  drachm),  croton  oil  (dose, 
1  to  3  drops,  given  rolled  up  in  a  bread  pill). 

A  few  additional  purgative  medicines  for  special  cases 
are  now  given: — (1)  For  habitual  costiveness  and  "wind 
in  the  stomach": — Sulphate  of  sodium,  2  drachms;  dilute 
sulphuric  acid,  1  drachm;  compound  infusion  of  gentian, 
to  6  ounces.  (Take  a  small  wineglassful  of  this  mixture 
after  the  two  principal  meals  every  day. )  (2)  As  a  purga- 
tive for  persons  with  rheumatic  gout: — Sulphate  of  soda, 
l!/2  ounces;  flowers  of  sulphur,  2  ounces;  (One  teaspoon- 
ful  in  a  tumbler  of  milk  on  rising  from  bed  every  morn- 
ing). (3)  For  anaemic  women,  with  headaches,  costive- 
ness,  and  stoppage  of  the  monthly  flow: — Granulated 


RASHES  OF  THE  SKIN,  ARTIFICIAL     231 

sulphate  of  iron,  2  grains ;  pill  of  aloes  and  myrrh,  3  grains. 
(To  make  one  pill.  Let  the  patient  take  one  such  pill 
thrice  daily,  after  meals.)  (4)  To  relieve  the  fullness  of 
dropsy: — Podophyllin  resin,  6  grains;  ginger  powder,  20 
grains;  extract  of  hyoscyamus,  24  grains.  (Divide  the 
mass  into  12  pills,  and  let  the  patient  take  2  every  other 
night,  at  bedtime.)  (5)  A  laxative  for  children  with 
costive  bowels.  A  stock  of  this  medicine  to  be  kept  in 
cupboard  at  home: — Rhubarb  powder,  45  grains;  mag- 
nesium carbonate,  3  drachms ;  dill  water,  4%  fluid  ounces. 
(Mix  well  and  give  the  infant  a  teaspoonful  every  two 
hours  until  the  bowels  are  freely  moved.)  (6)  Another 
purge  for  persons  with  dropsy  in  any  part  of  the  body: — 
Elaterium,  1  grain;  extract  of  gentian,  12  grains.  (For 
four  pills.  Let  the  patient  take  one  every  night.) 

Quinsy. — This  means  the  abscess  which  forms  in  the  back 
of  the  throat  sometimes  as  a  result  of  inflammation  of  the 
tonsils.  It  ought  to  be  opened  by  the  surgeon;  if  left  to 
itself,  it  will  burst  in  time,  but  it  may  burst  during  sleep 
and  suffocate  the  patient.  It  ought  not  to  be  left  un- 
treated. (See  also  "Sore-Throat.") 

Rashes  on  the  Skin,  Artificial. — These  eruptions  are  those 
which  are  not  due  to  some  internal  disease,  such  as  scarlet 
fever,  but  which  are  mostly  caused  by  some  substance  ap- 
plied to  the  skin.  Soldiers  and  sailors,  and  others,  such  as 
professional  beggars  and  tramps,  sometimes  make  them- 
selves ill  in  this  way  in  order  to  escape  service  or  duty, 
or  to  prey  upon  the  sympathy  and  charity  of  the  kind- 
hearted.  These  sham  eruptions  come  under  two  main 
headings : — 

A. —  (1)  Eruptions  caused  by  external  agents,  (a) 
Animals — such  as  lice,  fleas,  bugs,  jellyfish,  gnats,  mos- 
quitoes, wasps,  and  the  irritating  discharge  of  ulcers, 
carbuncles,  and  the  urine  in  diabetes.  (6)  Vegetable — 
such  as  germs  of  some  kinds,  orange-peel  juice,  arnica, 
poison-oak,  poison-ivy,  mustard.  Most  of  these  produce  a 
rash  like  that  of  eczema. 

(2)  Trade  eruptions,  among  those  who  handle  paraffin, 
tar,  sugar  (grocer's  itch),  salt,  lime,  cotton  oil,  etc.,  and 
such    people    as    chemists,    dyers,    tanners,    paperhangers, 
bakers. 

(3)  The  eruptions  of  beggars  and  tramps  are  often  pro- 
duced purposely  by  the  patients  themselves  to  excite  pity. 


232  RASHES  OF  THE  SKIN 

The  chief  offenders  are  hysterical  girls,  who  cannot  get  as 
much  attention  paid  to  them  as  they  desire;  prisoners; 
deserting  soldiers  and  sailors;  and  lunatics.  The  sub- 
stances used  are  such  as  croton  oil,  acids,  turpentine, 
iodine,  mustard,  Spanish  fly,  urine.  A  few  of  these 
malingerers  are  very  clever,  but  not  quite  clever  enough 
to  deceive  a  doctor  for  very  long,  because  they  produce 
rashes  which  are  not  seen  in  disease,  and  suggest  ''art" 
rather  than  "nature."  In  the  French  army  the  soldiers 
use  thapsia  root,  and  sometimes  get  erysipelas  from  it. 
Rogues  of  this  kind  will  often  inflict  much  pain  on  them- 
selves. 

B. — The  other  type  of  artificial  eruptions  is  produced 
by  drugs  taken  internally.  The  rash  caused  by  too  much 
antipyrin,  for  example,  is  often  like  that  of  a  certain  dis- 
ease, but  there  are  generally  ways  of  distinguishing  it,  and 
doctors  are  generally  on  the  alert  for  these  drug  rashes. 
Bromides  (given  for  sleeplessness  or  epilepsy)  produce  an 
artificial  eruption  (in  some  people)  like  acne.  So  may 
iodides,  arsenic,  chloral,  mercury,  belladonna,  quinine, 
opium  and  others. 

RASHES  ON  THE  SKIN. —  (1)  A  rash  coming  out  in  crops, 
first  on  chest,  stomach  and  neck,  then  on  wrists  and  the 
rest  of  the  limbs,  and  accompanied  by  a  sore  throat  and 
feverishness  which  has  lasted  one  day  only,  is  likely  to  be 
the  rash  of  scarlet  fever  (scarlatina).  Send  for  the  doctor 
at  once. 

(2)  A  rash  appearing  at  the  beginning  of  an  illness  or 
without  any  feeling  of  illness,   coming  out  in  crops,  on 
the  face,  shoulders,  back,  and  scalp,  with  tiny  red  pimples 
which  very  soon  become  blebs — is  probably  chicken-pox. 
Send  for  the  doctor  at  once. 

(3)  A  rash,  first  seen  on  the  face,  of  hard  red  pimples 
which  feel  like  shot  embedded  in  the  skin,   and  accom- 
panied by  pain  in  the  bottom  of  the  back,  and  fever  and 
headache   and  vomiting  of  three   days'   duration — is   the 
rash  of  smallpox.     Send  for  the  doctor  at  once,  or  go  to 
the  nearest  vaccination  station  and  get  vaccinated. 

(4)  A  rash  of  red  patches  with  round  scooped-out  edges, 
which  appears  on  the  fourth  day  of  illness,  and  is  seen 
first  on  the  face,  then  on  the  body,  and  then  on  the  limbs, 
and  is  accompanied  by  the  signs  of  a  bad  cold  in  the  head, 
cough  and  feverishness — is  the  rash  of  measles.    Send  for 


RED  GTJM  233 

the  doctor  and  see  that  no  other  children  go  anywhere  near 
the  diseased  one. 

(5)  The  rash  of  German  measles  is  variable. 

(6)  Small  red  spots  with  deep-purple  points  in  the  cen- 
ter of  them  are  generally  due  to  flea  ~bites.     Old  flea  bites 
might  be  mistaken  for  a  skin  disease,  but  marks  on  the 
linen  and  clothes  will  perhaps  show  what  the  spots  are 
caused  by. 

(7)  Wheals  on  the  skin  with  whitish  middle  parts  and 
a  central  blueish  spot,  are  caused  by  bug  bites.    Bugs  in- 
ject a  poison  into  the  skin  which  makes  it  swell  so  that 
the  bug  may  have  a  better  supply  of  blood  to  feed  upon. 
Toilet  vinegar  and  lead  lotion  are  both  good  for  bug  bites. 

(8)  See  also  "Lice.'; 

(9)  Sometimes  a  patient  taking  medicine  by  the  doctor's 
orders  gets  a  skin  eruption  or  rash,  which  ought  to  be  re- 
ported at  once  to  the  doctor.     Some  people  are  too  sus- 
ceptible to  some  medicines  and  the  dose  will  require  to  be 
regulated  by  him. 

The  commoner  medicines  which  sometimes  cause  rashes 
are  ether,  bromides,  iodides,  chloral,  quinine,  antipyrin 
and  belladonna. 

(10)  A  rash  of  tiny  blebs  like  drops  of  dew  on  the  skin 
is  probably  a  rash  due  to  too  much  perspiration.     It  should 
be  dusted  with  violet  powder  or  fuller's  earth. 

(11)  A  rash  which  consists  of  wheals,   flattened,   and 
feeling  hard  and  firm ;  at  first  red,  then  white  and  blood- 
less with  a  bright  pink  edge;  and  surrounded  by  a  red 
halo — is  the  rash  of  nettlerash.     In  bad  cases  the  whole 
skin  is  red  and  the  wheals  stand  out  in  white  patches 
upon  it. 

It  comes  on  quite  suddenly  and  itches  and  burns,  but 
wherever  the  scratching  is  done  fresh  wheals  appear.  (See 
"Nettlerash.") 

(12)  Rashes  may  be  caused  by  various  irritants,  such 
as  the  stings  of  wasps,  jellyfish,  and  stinging  nettles;  of 
gnats   and   mosquitoes,    and   of   hairy   caterpillars.     (See 
"Rashes,  Artificial.") 

Red  Gum. — This  is  a  skin  disease,  seen  only  in  babies, 
and  is  associated  with  the  cutting  of  the  first  teeth.  It 
is  shown  by  pink  pimples  on  the  skin  of  face,  body  or 
limbs,  sometimes  in  patches,  at  other  times  in  single 
pimples.  They  do  not  last  many  days,  often  come  and 


234  RHEUMATISM 

go,  and  do  not  ulcerate;  they  may  alternate  with  a  loose- 
ness of  the  bowels.  Pay  strict  attention  to  diet,  and  avoid 
all  chills  to  the  skin.  Give  a  dose  of  rhubarb  and  soda, 
in  amount  according  to  the  age  of  the  infant,  and  smear 
a  little  zinc  ointment  over  the  spots. 

Refuse  Disposal. — Refuse  may  be  divided  into  three  chief 
classes — house  sweepings  and  ashes;  garbage;  and  sewage 
(see  i l Sewage  Disposal ") .  The  substances  composing  tho&e 
three  classes  should  be  disposed  of  separately. 

Ashes  may  be  disposed  of  by  the  producer  in  the  coun- 
try for  paths,  roads  or  filling-in,  or  they  may  be  collected 
by  municipal  or  town  authorities  to  be  disposed  of  as  they 
see  fit. 

Garbage  should  be  collected  in  covered  galvanized  cans 
which  are  emptied  frequently  (daily). 

In  the  country  garbage  may  be  consumed  by  pigs,  or 
dumped  on  a  garbage  heap,  which  is  disposed  of  at  longer 
intervals.  Both  garbage  heap  and  pigpen  should  be 
screened  to  prevent  the  access  of  flies,  which  find  garbage 
an  ideal  breeding  ground. 

The  most  sanitary  method  of  garbage  disposal  for  both 
city  and  country  is  by  the  use  of  garbage  destroyers  or 
incinerators.  Small  ones  are  now  manufactured  which 
can  be  placed  in  kitchens,  and  garbage  can  thus  be  de- 
stroyed as  soon  as  it  collects. 

Garbage  and  refuse  are  collected  in  settled  districts  by 
the  municipalities  or  towns  and  are  then  best  disposed  of 
by  garbage  crematories,  furnaces  or  destructors. 

Rheumatism. — This  disease  occurs  in  several  forms.  The 
most  serious  cases  are  those  of  acute  rheumatism,  also 
called  rheumatic  fever  (see  " Acute").  Chronic  rheu- 
matism may  be  left  behind  in  the  joints  when  the  acute 
form  passes  off,  and  the"  same  name  is  also  given  to  a  similar 
affection  of  the  muscles.  Rheumatism  of  the  loins  is  com- 
monly called  lumbago,  and  when  the  pain  goes  down  the 
back  of  the  thigh  it  is  called  sciatica.  It  may  here  be 
remarked  that  all  these  terms  are  very  inaccurately  and 
carelessly  used.  As  a  fact  the  pains  in  these  cases  are  very 
little  understood  even  by  doctors  themselves.  Hence  much 
difference  of  opinion.  The  muscles  of  the  shoulders,  ribs 
and  arms  may  also  suffer.  There  is  also  a  form  of  this 
disease  called  rheumatic  arthritis,  in  which  the  toes  and 
fingers  become  swollen,  painful,  and  gradually  so  deformed 


RHEUMATIC  FEVER  235 

until  they  are  useless.  The  chronic  forms  of  rheumatism 
are  associated  with  great  pain,  but  an  absence  of  fever. 

Rheumatic  fever  is  a  formidable  disease,  lasting  some- 
times for  weeks.  In  it  there  are  severe  pains  in  several  of 
the  large  joints,  high  fever,  great  weakness,  and  an  ex- 
treme liability  to  have  inflammation  attacking  the  valves 
inside  the  heart.  It  has  been  supposed  that  the  disease 
depends  on  the  formation  of  a  peculiar  chemical  compound 
called  lactic  acid  in  the  blood,  and  that  this  acid  attacks 
the  fibrous  structures  of  the  joints,  causing  them  to  in- 
flame, swell,  and  contain  an  excess  of  watery  fluid.  For 
a  long  period  it  has  been  supposed  that  the  immediate  and 
only  cause  of  attacks  were  chills,  exposure  to  cold  and 
damp,  when  the  person  is  in  a  weak  or  unhealthy  state. 
But  more  recent  arguments  and  researches  seem  to  show 
that  rheumatism  is,  like  most  others,  a  germ  disease. 

The  symptoms  are  shivering,  malaise,  nausea,  and  head- 
ache, with  restlessness,  passing  on  into  a  state  of  fever; 
next  day  there  is  an  onset  of  painful  stiffness  in  one  or 
more  joints,  often  the  knees  or  elbows,  the  hips  or  the 
wrists;  the  fingers  and  toes  rarely  suffer.  The  patient 
feeling  great  heat,  with  violent  pain,  is  soon  rendered  a 
pitiable  spectacle  of  helpless  suffering.  He  dare  not  move, 
because  each  movement  increases  the  pain,  which  becomes 
agonizing,  even  the  weight  of  the  bedclothes  can  hardly  be 
borne,  the  skin  becomes  bathed  in  sweat  of  a  peculiarly 
offensive,  sour  smell ;  the  pulse  is  full  and  bounding ;  there 
may  be  constipation  or  diarrhea,  the  tongue  is  furred,  and 
the  water  is  scanty  and  high-colored;  the  disease  passes 
from  one  joint  to  another,  and  relapses  are  common. 

Treatment. — Absolute  rest  in  bed  is  necessary,  lying  be- 
tween blankets  on  a  hard  hair  mattress  with  the  affected 
joints  wrapped  in  wool,  or  covered  with  warm  fomenta- 
tions. The  most  reliable  modes  of  treatment  are  by  the 
salicylate  of  soda,  aspirin,  salicin,  bicarbonate  of  potash, 
and  similar  medicines. 

The  three  different  types  of  the  medicinal  treatment  of 
an  acutely  inflamed  rheumatic  joint  (whether  the  case  is 
severe  enough  to  call  "rheumatic  fever"  or  not)  are: — 
(1)  The  salicylate  treatment,  (2)  the  opium  and  salicylate 
treatment,  (3)  the  alkaline  treatment.  The  first  is  the 
best,  generally  speaking,  though  some  patients  cannot  take 
enough  salicylates,  because  of  the  humming  noises  they  pro- 


236  RHEUMATISM,  CHRONIC 

duce  in  the  head.  It  is  certain  that  this  medicine  relieves 
the  pain  in  the  joints,  whether  it  cuts  short  the  attack 
or  not.  We  give  below  two  useful  prescriptions: — 
Salicylate  of  soda,  3  drachms;  syrup  of  ginger,  1  ounce; 
water,  6  ounces.  A  tablespoonful  to  be  taken  every  three 
hours  while  the  joints  are  hot  and  painful  (for  an  adult). 
Tincture  of  opium,  1  ounce ;  potassium  carbonate,  %  ounce ; 
glycerin,  2  ounces;  water,  12  ounces.  To  make  a  lotion; 
to  be  applied  on  lint  to  the  painful  joint.  (Poison — not 
to  be  taken.) 

Diet  in  Acute  Rheumatism. — 

FORBIDDEN  ARTICLES  OF  FOOD. — Beef  tea,  meat  extracts, 
pastry,  sweets,  sugar  in  all  forms,  alcoholic  drinks  of 
every  kind. 

ALLOWED. — While  the  joints  are  red  and  tender  and 
there  is  inflammation — milk,  milk  and  soda,  peptonized 
milk;  fruit  jellies,  oatmeal  gruel,  barley  water,  home- 
made lemonade,  weak  tea,  malt  extract. 

When  the  fever  has  abated — light  clear  soups  and  broths, 
vegetables,  chicken,  light  puddings,  bread  and  milk,  ar- 
rowroot. 

After  a  fortnight  without  fever — Bread  and  butter, 
eggs,  white  fish,  chicken,  pounded  lean  beef  or  mutton  or 
veal,  stewed  celery,  spinach,  potatoes,  seakale,  asparagus, 
grapes. 

Rheumatism,  Chronic. — Kheumatism  in  its  chronic  forms 
and  stages  manifests  itself  in  numerous  ways;  it  is  an  ail- 
ment that  varies  perhaps  more  than  any  other,  both  in 
the  parts  affected  and  the  severity  of  the  pains.  (See 
"  Acute.") 

The  disease  may  appear  as  lumbago,  or  pain,  with  stiff- 
ness, may  affect  the  neck,  or  any  one  of  the  joints;  or  it 
may  specially  attack  muscles,  such  as  those  between  the 
ribs,  or  over  the  shoulder,  or  the  scalp  of  the  head. 

All  these  forms  of  rheumatism  are  worst  in  cold 
weather,  especially  after  exposure  to  wet  and  cold  com- 
bined; they  are  also  often  related  to  certain  forms  of  in- 
digestion, and  in  most  rheumatic  persons  they  can  be 
brought  on  by  indulgence  in  beer. 

Every  attack  which  occurs  renders  the  sufferer  more 
liable  to  further  attacks,  and  many  persons  suffer  from 
rheumatism  every  few  weeks  from  middle  life  to  old  age. 

Repeated  attacks  are  liable  to  lead  to  further  changes, 


RHEUMATISM  237 

for  the  muscles  may  waste  and  lose  power,  and  the  bones 
of  the  joints  may  grow  out — that  is,  become  enlarged  and 
deformed. 

All  rheumatic  patients  should  pay  great  attention  to 
three  points — diet,  warmth,  and  excretions  (i.  e.,  bowels 
and  urine)  and  perspiration.  By  these  means  attacks 
may  be  seldom  felt,  while  errors  as  to  these  points  may 
lead  to  much  suffering  at  any  time.  It  is  wise  to  take  a 
saline  purgative,  such  as  a  mixture  of  sulphate  of  mag- 
nesia with  bicarbonate  of  potash,  in  water,  more  or  less 
regularly,  without  waiting  for  symptoms  of  illness.  The 
skin  also  should  be  kept  thoroughly  and  frequently 
cleansed  with  warm  baths.  The  action  of  the  kidneys 
should  be  sustained  by  an  occasional  dose  of  weak  warm 
gin  and  water  at  bedtime. 

Chills  must  be  avoided  by  wearing  woolen  clothing, 
thick  socks,  and  by  the  removal  of  wet  boots  at  the  earliest 
possible  moment. 

The  diet  should  be  very  simple,  with  only  a  small  quan- 
tity of  meat;  salted  dry  meats  are  especially  to  be 
avoided.  Very  little  sugar  should  be  taken.  All  starchy 
foods  are  likely  to  be  harmless,  as  is  milk,  and  also  eggs, 
so  that  a  very  excellent  diet  consists  of  boiled  and  baked 
puddings  of  arrowfat,  maizena,  sago,  tapioca,  and 
macaroni,  made  with  good  cow's  milk  and  eggs.  All 
cooked  vegetables  will  help  to  maintain  the  purity  of  the 
blood,  and  many  varieties  of  fruit,  such  as  oranges, 
lemons,  bananas,  pomegranates,  cooked  apples,  and  prunes, 
may  be  taken  with  advantage. 

As  already  said,  beer  almost  always  does  harm,  while 
the  French  and  German  light  wines,  being  of  an  acid 
nature,  are  unsuitable.  The  safest  drinks  are  soda  or 
potash  water,  to  which  a  little  malt  whisky  or  good  brandy 
may  be  added,  and  these  should  be  taken  only  with  meals. 

Medicines. —  (1)  Powdered  guaiacum  resin,  1  drachm; 
potassium  iodide,  1  drachm;  tincture  of  colchicum  seeds, 
3  drachms;  syrup,  2  ounces;  cinnamon  water  to  6  ounces. 
A  dessertspoonful  of  this  mixture  to  be  taken  twice  a  day. 
An  excellent  medicine  for  old  chronic  rheumatism  of  the 
large  joints.  (2)  Veratrine,  1  drachm;  protoiodide  of 
mercury,  1  drachm ;  vaselin,  1  ounce ;  an  ointment  to  be 
gently  rubbed  into  the  joints.  (3)  Guaiacum  powder,  1% 
drachm;  capsicum  powder,  15  grains;  pill  aloes  et  asa- 


238  RHEUMATIC  GOUT 


foetida,  1%  drachm.     Divide  mass  into  60  pills.     Take  one 
three  times  a  day,  if  preferred  to  liquid  medicine. 

Rheumatic  Gout  (Rheumatic  Arthritis),  —  This  is  a  name 
applied  to  many  cases  of  chronic,  painful  joint  disease, 
which  differ  from  gout  as  much  as  from  simple  rheu- 
matism. Rheumatic  gout  affects  persons  of  middle  age, 
or  old  people,  and  is  not  seen  in  children.  It  is  essentially 
a  chronic  disease,  and  it  tends  to  grow  gradually  worse 
and  worse,  to  last  for  years,  and  until  death  occurs  from 
some  other  disease.  Both  sexes  suffer  about  equally.  It 
is  essentially  a  disease  of  the  joints,  and  it  is  not  related 
to  rheumatism  of  the  muscles  so  common  in  old  age.  Its 
onset  is  generally  slow  and  gradual,  but  in  some  cases 
there  are  occasional  feverish  attacks.  A  man  or  woman 
begins  to  feel  unwell  and  weaker  than  before,  easily 
fatigued,  loses  appetite,  and  has  vague  pains  in  the  head, 
back,  and  limbs.  The  digestion  is  disordered,  and  the 
bowels  are  irregular,  and  the  urine  often  high-colored; 
the  sufferer  is  restless,  uneasy,  and  sleeps  badly.  Soon 
afterwards  some  of  the  joints  become  affected;  pain  is 
present  more  or  less  continuously,  and  the  joints  are  puffy 
and  enlarged,  but  not  hot  and  burning  with  acute  inflam- 
mation. The  joints  are  stiff,  and  can  only  be  moved  with 
some  difficulty  and  increase  of  pain;  and  so  if  the  hip, 
knee,  or  ankle  is  affected,  the  patient  is  rendered  lame. 
In  some  cases  a  peculiar  sort  of  crackling  or  creaking 
noise  can  be  made  by  handling  and  rubbing  the  joint, 
which,  nevertheless,  often  seems  to  contain  too  great  a 
supply  of  oil  within  it.  One  joint  becomes  affected  after 
another,  and  this  is  often  seen  in  the  several  joints  of  the 
fingers  and  thumb.  After  causing  mild  suffering  for 
months  or  years,  the  joints  become  really  enlarged  with 
hard,  bony  outgrowths,  and  the  gristle  part  of  the  joint 
becomes  destroyed.  In  this  way  a  joint  becomes  too  large, 
too  hard,  deformed  and  useless.  Following  this  destruction 
of  the  tissues  forming  the  joint,  the  nerves  of  the  parts 
around  become  irritated,  which  gives  rise  to  spasms  and 
cramps  of  the  affected  limb.  All  these  troubles  leading 
to  weary  days  and  disturbed  nights,  break  down  the  gen- 
eral health  gradually,  and  the  patient  becomes  melan- 
choly, and,  on  account  of  the  debility,  always  feels  chilled 
and  depressed;  he  catches  cold  easily,  and  so  often  suffers 
from  bronchitis;  and  such  cases  often  end  with  conges- 


RICKETS  239 

tion  of  the  lungs.  This  is  a  very  intractable  disorder,  for 
while  gout  is  more  or  less  controlled  by  colchicum  and 
iodide  of  potassium,  and  rheumatism  by  the  salicylate  of 
soda  and  bicarbonate  of  potash,  this  form  of  disease  is 
not  checked  by  any  drug  known  to  medical  science,  and 
the  only  hope  of  cure  lies  in  the  possibility  of  building  up 
the  constitution  with  fresh  air,  change  of  climate,  regular 
exercise,  with  carefully-arranged  diet. 

Rickets. — This  is  a  disease  which  affects  children,  and 
may  be  observed  soon  after  birth,  or  not  until  the  child 
is  several  years  of  age.  It  is  a  form  of  weakness  caused 
by  unsuitable  and  insufficient  food,  and  the  tendency  to  it 
may  be  inherited  from  one  or  both  parents  who  were  af- 
fected by  rickets  in  their  childhood,  or  it  may  be  the 
result  of  birth  from  parents  who  were  delicate  in  health 
from  overwork  or  from  scanty  food  at  the  time  of  the  in- 
fant's development  and  suckling. 

Poverty  of  the  suckling  mother  is  the  most  certain 
cause,  as  this  is  generally  associated  with  unhealthy  homes, 
and  often  with  overwork.  It  is  most  apt  to  occur  in  the 
latter  children  of  a  family  when  the  mother  has  had  too 
many  children  for  her  strength,  or  has  had  children  too 
fast,  especially  when  the  means  of  the  father  have  not 
improved  with  the  passing  years. 

There  can  be  no  doubt  that  children  with  congenital 
syphilis  often  develop  rickets  (see  "Syphilis").  Some- 
times it  has  seemed  that  a  lack  of  lime  salts  in  the  food 
has  caused  the  onset  of  rickets,  and  so  the  cod-liver-oil 
emulsion  and  the  hypophosphite  of  lime  mixtures  sold  by 
chemists  often  do  good.  But  not  every  case  is  cured  by 
lime  salts.  There  is  hardly  a  tissue  in  the  body  which  is 
not  affected  in  the  disease  called  rickets. 

The  bones  are  soft  and  bendable,  because  they  are  want- 
ing in  lime  salts,  and  they  do  not  develop  in  the  usual 
way.  The  chest  of  a  rickety  child  is  badly  shaped,  and 
perhaps  "pigeon-breasted."  The  ends  of  the  ribs  in  front 
are  enlarged  and  feel  like  knobs  under  the  skin.  The 
elbows,  wrists,  knees  and  ankles  are  too  large  and  knobby, 
and  the  legs  get  bow-legged  because  they  are  too  weak  to 
bear  the  child's  weight.  The  spine  sometimes  gives  way 
under  the  child's  weight  and  may  be  bent  forwards  or 
sideways.  The  skull  is  too  big  and  bulgy,  and  so  the  face 
looks  too  small;  and  the  two  soft  places  that  you  always 


240  SALISBURY  TREATMENT 

find  on  a  child's  head,  and  which  generally  "close  up"  in 
a  few  months  still  remain  "open"  beneath  the  skin,  and 
soft  for  a  year  or  two.  A  rickety  baby  often  grows  into 
a  deformed  child,  and  dies  of  rheumatism,  St.  Vitus' 
Dance,  or  some  similar  disease  before  reaching  adult  age. 
The  bony  girdle  at  the  hips  may  grow  much  out  of  shape 
and  give  much  trouble,  if  the  child  is  a  girl,  when  the  time 
comes  for  her  to  give  birth  to  a  baby. 

The  blood  is  poor  in  quality  in  rickets.  The  spleen  and 
liver  are  often  too  big.  The  results  of  the  disease  of  the 
tissues  are  to  produce  tenderness  of  the  body  of  the  child,  so 
that  it  cries  when  it  is  played  with  or  rubbed.  It  throws 
off  the  bedclothes  at  night.  Its  head  is  hot  and  perspir- 
ing. Its  stools  (or  motions)  are  green,  pasty,  watery,  and 
smell  very  badly.  The  child  is  very  liable  to  spasms,  fits, 
convulsions,  squinting. 

No  case  of  disease  deserves  more  careful  treatment,  but 
it  is  almost  useless  to  lay  down  a  routine  of  treatment,  as 
cases  vary  so  much.  The  efforts  of  the  child's  parents 
must  be  directed  towards  the  improvement  of  the  general 
health,  by  fresh  air,  sunlight,  and  a  life  in  the  country, 
or  by  the  seaside.  Plenty  of  milk,  cream,  and  eggs  are 
wanted,  and  plenty  of  fresh  fruit  and  vegetables.  The 
most  useful  medicines  are  cod-liver  oil,  saccharated  solution 
of  lime,  phosphates,  quinine,  iron,  iodide  of  iron,  and  so  on. 

Ringworm. —  (See  "Skin  Diseases"  V.) 

Rupture.—  (See  "Hernia.") 

Salisbury  Treatment,  The. — This  is  a  system  of  treatment 
chiefly  useful  for  persons  who  are  much  too  fat  and  who 
are  at  the  same  time  not  in  any  way  gouty.  Gout  and 
Bright 's  disease  must  not  be  treated  by  this  system.  The 
Salisbury  method  is  to  feed  the  patient  on  an  entirely  meat 
diet,  giving  him  about  three  pounds  of  lean  beef  every 
day  and  almost  nothing  else  except  plenty  of  hot  water 
to  drink.  After  one  week  of  treatment  the  patient  goes 
back  to  his  ordinary  diet  for  a  time.  The  scientific  value 
of  this  method,  according  to  the  inventor  of  it,  is  that  it 
gets  rid  of  all  "fermentative"  foods  and  that  the  large 
quantity  of  hot  water  drunk  acts  beneficially  by  carrying 
away  the  excess  of  uric  acid  which  there  is  sure  to  be  in 
such  a  purely  animal  diet,  and  forces  the  kidneys,  skin 
and  bowels  to  act  most  freely.  The  plan  of  treatment  is 
given  in  case  any  of  our  readers  would  like  to  try 


SALISBURY  TREATMENT  241 

this  method  at  home.  Persons  with  chronic  indigestion, 
dry  red  pointed  tongue,  and  pain  after  food  will  very  likely 
derive  benefit  from  the  Salisbury  method.  Very  fat  people 
may  give  it  a  trial  too.  Clearly  understand  that  the  Salis- 
bury diet  is  not  intended  as  a  permanent  diet.  It  is  to  be 
continued  "only  while  the  necessity  for  it  lasts/' 

The  Salisbury  dietary  is  as  follows : — 

(1)  There  are  to  be  three  meals  a  day. 

(2)  An  hour  and  a  half  before  each  meal  the  patient 
is  to  drink  one  pint  of  hot  water  about  100°  F.  or  a  little 
hotter.     It  is  to  be  sipped  slowly.     It  may  be  flavored 
with  lemon  juice,  or  a  little  tea  or  salt,  according  to  taste. 

(3)  Mealtimes  are  to  be  8  A.  M.,  1  p.  M.,  and  6.30  P.  M. 

(4)  The  minced  beef  may  be  flavored  with  pepper, 
or  mustard,  or  Chutney,  and  the  only  vegetables  allowed 
are  lettuce,  watercress  and  celery  (raw  or  cooked).     The 
least  amount  of  mince  taken  with  each  meal  is  to  be  two 
ounces,  and  the  largest  amount  allowed  at  any  one  meal 
is  16  ounces  (one  pound).     If  the  patient  is  still  hungry 
then,  he  must  take  the  whites  of  one  or  two  eggs  lightly 
poached,  between  meals.     He  must  not  exceed  six  eggs 
a  day.     The  feeling  of  weakness  that  this  diet  produces 
for  a  day  or  two  will  pass  off. 

(5)  A  little  aperient  medicine,  such  as  cascara,  may 
be  necessary  occasionally. 

(6)  If  after  a  long  course  of  treatment  the  patient 
is   sick    of    beef-mince    and   beef    cakes,    he    may    have 
(minced  before  being  cooked)    mutton,   lamb,   poultry, 
well-boiled  rice  or  macaroni,  as  additional  food,  but  these 
are  not  to  replace  the  beef  altogether. 

(7)  Instructions  for  making  beef-mince. — Cut  slices 
from  the  top  side  of  a  round  of  beef.     Cut  the  meat  into 
strips  and  scrape  away  all  fat  and  gristle.     Put  the  meat 
twice  through  the  mincing-machine.     Beat  up  the  pulp 
in  a  roomy  saucepan  with  cold  water,  in  the  proportion 
of  one  teaspoonful  of  water  to  one  ounce  of  pulp.     Add 
black  pepper  and  salt  to  taste. 

Cook  the  mince  slowly,  stirring  all  the  time,  until  the 
red  color  disappears.  This  will  take  about  twenty 
minutes. 

When  finished,  the  mince  should  be  a  smooth,  soft, 
jpasty  mass,  without  any  lumps  in  it,  aixd  is  .to  be  served 


242  SCARLET  FEVER 

in  a  hot  basin  and  eaten  from  a  teaspoon.  The  patient 
may  have  a  stick  or  two  of  raw  celery  if  he  wants  some- 
thing to  chew  with  it. 

(8)  Instructions  for  making  Salisbury  beef  cakes. — 
Take  minced  beef  pulp  prepared  as  already  described 
above,  season  it  to  taste,  and  turn  it  with  two  forks  into 
several  flat  round  cakes,  about  half  an  inch  thick,  and 
grill  them  over  a  clear  moderate  fire  for  about  six  minutes 
each. 

Scarlet  Fever  (Scarlatina) . — This  serious  disease,  to  which 
all  are  liable,  though  young  children  are  most  often  attacked, 
is  a  contagious  fever,  of  which  the  most  important  charac- 
ters are  sore  throat  and  a  bright  red  rash  on  the  skin ;  and 
the  most  important  complication  is  inflammation  of  the 
kidneys.  (See  also  "Infection.")  The  poison  of  it  clings 
to  clothing  and  articles  that  have  been  used  for  the  sick, 
sometimes  for  months,  and  often  lying  harmless  for  a  long 
time  may  suddenly  start  the  disease  again  if  it  finds  a  per- 
son who  is  weakly  or  susceptible. 

As  a  rule,  a  person  who  has  "caught"  scarlet  fever  falls 
ill  within  two  days.  He  shivers,  vomits,  and  complains  of 
headache  and  backache,  and  cannot  eat  or  sleep.  Then 
comes  a  bad  sore  throat.  On  the  second  day  appears  a  red 
rash  (see  "Bashes  on  the  Skin,"  No.  1).  This  rash  begins 
to  fade  about  the  sixth  day  of  illness,  and  then  begins 
"peeling."  The  skin  shreds  off  in  tiny  flakes,  or  even  in 
large  flakes,  and  these  little  scales  are  very  contagious. 
This  goes  on  sometimes  for  six  weeks  or  more.  As  to  the 
throat,  it  is  red,  swollen,  and  painful  and  tender.  The 
tongue  is  bright  red.  The  fever  is  high.  In  most  cases 
the  disease  is  at  its  height  about  the  sixth  day  of  illness,  and 
after  that  the  patient  slowly  gets  better.  In  fatal  cases 
the  patient  dies  from  exhaustion  after  about  five  days  of 
severe  illness. 

The  complications  of  scarlet  fever  may  be  terrible.  The 
tonsils  and  the  palate  may  ulcerate;  the  glands  under  the 
jaw  may  enlarge  into  a  brawny  hard  swelling  and  undergo 
mortification.  This  generally  kills  the  patient.  The  mid- 
dle ear  (see  "Ear  Diseases")  may  become  attacked,  and 
the  patient  will  probably  then  be  deaf  and  have  a  discharge 
from  the  ears  for  the  rest  of  his  life.  But  the  most  seri- 
ous of  all  are  inflammation  of  the  kidneys — which  may 


SCIATICA  243 

come  on  during  convalescence  and  lead  to  dropsy,  etc., — 
and  scarlatinal  rheumatism,  which  may  leave  the  patient 
with  heart  disease. 

Treatment. — The  general  measures  to  be  taken  as  to  iso- 
lation are  described  under  the  treatment  of  measles  (which 
see).  A  sheet  dipped  in  and  kept  always  wet  with  1  in  100 
carbolic  acid  lotion  must  be  hung  up  to  cut  off  the  sick  room 
from  the  rest  of  the  house.  From  the  very  first  it  is  a  good 
plan  to  anoint  the  patient's  body  daily  with  1  in  50  carbolic 
oil.  Washing  the  body  daily  with  weak  disinfectant  lotions 
is  only  to  be  done  during  convalescence.  The  medicines 
must,  of  course,  be  left  to  the  doctor  in  attendance.  A 
throat  spray  should  always  be  used ;  it  lessens  the  risk  of  ear 
complications.  Such  a  spray  is  the  following: — Glycerin 
of  carbolic  acid,  3  drachms ;  glycerin  of  borax,  3  drachms ; 
rose  water  to  half-a-pint.  Isolation  must  be  kept  up  for  at 
least  six  weeks.  It  is  of  the  very  highest  importance  to 
guard  against  chills  during  the  convalescence. 

Sciatica, — This  word  means  neuralgia  (nerve  pain)  or 
actual  neuritis  (nerve  inflammation)  of  the  sciatic  nerve, 
which  lies  under  the  muscles  at  the  back  of  the  thigh  from 
the  buttocks  to  the  heel.  It  is  generally  caused,  in  the  first 
place,  by  exposure  to  wet  and  cold,  as  by  sitting  on  cold 
stone,  or  lying  on  wet  grass;  and,  once  contracted,  sciatica 
is  often  very  difficult  to  get  rid  of.  Persons  with  sciatica 
have  pain  more  or  less  along  the  whole  length  of  the  nerve, 
even  down  into  the  heel,  and  tender  spots  at  various  points 
on  the  back  of  the  thigh.  If  it  goes  on  for  a  long  time, 
there  is  generally  some  wasting  of  the  muscles  and  flesh  of 
the  thigh. 

Occasionally,  sciatica  is  a  sign  of  some  spinal  disease. 

Acute  sciatica,  coming  on  suddenly  after  some  indiscre- 
tion, like  sitting  on  a  cold  stone,  should  be  treated  thus: — 
Get  the  sufferer  to  bed,  wrap  him  up  warmly,  and  give  him 
two  or  three  grains  of  calomel,  followed  by  two  Seidlitz 
powders  next  morning.  About  the  same  time  as  the  dose 
of  calomel,  let  him  take  15  grains  of  Dover's  powder. 
(This  is  a  pharmacopoeial,  and  not  a  patent  medicine.) 

Very  chronic  sciatica  ought  to  be  treated  by  a  long  rest 
in  bed  and  dry  cupping  over  the  course  of  the  nerve,  along 
the  thigh.  Both  acute  and  chronic  sciatica  will  need  spe- 
cial medicines  for  the  relief  of  pain,  and  morphine  or  co- 
caine may  have  to  be  injected  under  the  skin;  of  course, 


244  SCROFULA 

these  drugs  can  only  be  safely  administered  by  a  doctor. 
Moreover,  in  most  cases  of  sciatica,  the  patient  is  already 
tainted  with  gout,  or  rheumatism,  or  alcoholism,  or  syphilis, 
and  the  treatment  proper  to  these  diseases  must  also  be 
administered.  Sufferers  from  sciatica  might  like  to  try  one 
of  the  following  formulas : — 

(1)  Phenacetin,  50  grains;  salol,  50  grains;  caffeine,  5 
grains.     Divide  into  10  cachets,  and  take  from  two 
to  four  cachets  daily,  in  recent  case  of  sciatica;  or 

(2)  Spirit  of  turpentine,  %  ounce;  pure  honey,  1^2 
ounce.     Make  a  confection,  and  take  a  teaspoonful 
night  and  morning;  or 

(3)  Salophen,  10  to  40  grains,  in  cachets.     Three  or 
more  cachets  to  be  taken  daily  in  cases  of  sciatica 
in  rheumatic  person.     Aspirin  has  also  had  its  ad- 
vocates in  10  grain  doses,  thrice  daily. 

(4)  Several  liniments  are  in  common  use,  but  let  the 
sufferer  remember  that  most  cases  of  sciatica  are 
neuritis  and  not  neuralgia  alone.     Hence  the  re- 
lief obtained  by  rubbing  liniments  in  is  only  tem- 
porary.    Good    liniments    for    this    purpose    are 
chloroform,  belladonna,  aconite  of  turpentine  or 
camphor  liniments. 

(5)  Many  cases  of  sciatica  get  relief  from  the  injection 
under  the  skin  of  pure  water ;  others  like  injections 
of  cocaine;  others  of  chloroform. 

(6)  Leeches  put  on  over  the  painful  spot  often  give 
much  relief. 

(7)  Great  heat,  locally  applied,  as  in  the  Sprague  sys- 
tem, often  cures  the  neuritis  altogether. 

(8)  Alcohol,  one  of  the  chief  causes  of  neuritis,  does 
harm  in  all  cases,  and  ought  never  to  be  taken. 

Scrofula. — A  child  or  person  is  said  to  be  scrofulous  when 
he  or  she  suffers  from  a  special  liability  to  diseases  caused 
by  the  germ  of  tuberculosis  or  consumption — ' '  the  tubercle 
bacillus."  The  word  is  dropping  out  of  use  nowadays. 
There  used  to  be  an  idea  that  there  were  only  two  types 
of  body  which  were  especially  liable  to  be  attacked  by 
tubercle.  But  it  is  quite  certain  that  there  is  no  type  of 
individual  which  cannot  become  infected,  though  some 
types  are  still  recognized  as  being  more  prone  than  others 


SCURF  245 

to  the  disease.  The  two  "scrofulous"  types  are — (1) 
Those  persons  with  coarse  hair,  coarse  features  and  greasy 
skins,  of  poor  muscular  development  and  long,  flat  chests, 
and  (2)  those  of  somewhat  delicate  beauty,  with  pink  and 
white  delicate  skins,  large  eyes,  soft  dimpled  flesh,  downy 
hair  over  the  face,  neck  and  arms,  keen  perceptions,  lovable 
dispositions,  and  bright  intellect.  The  word  struma  means 
much  the  same  as  scrofula.  Old  country  doctors  still 
sometimes  call  only  tuberculous  disease  of  the  lungs  "con- 
sumption"; tuberculous  disease  of  a  joint  "scrofulous 
joint";  and  tuberculous  infection  of  the  glands  "strumous 
glands ' ' ;  although  as  a  fact  the  disease  is  the  same  in  all 
these  cases — caused  by  a  deposit  of  "tuberculous  matter" 
in  the  part  affected.  (See  "Tubercle.") 

Scurf. — This  is  a  very  different  thing  from  scurvy,  which 
is  a  blood  disease.  Scurf  is  a  disorder  of  the  skin  of  the 
head  and  hairy  scalp.  There  are  two  chief  varieties  of 
scurf — (1)  a  greasy,  oily  scurfiness  of  the  skin,  with  flakes 
of  reddish-brown  scurf  skin  and  red  blotches,  which  may 
spread  from  the  scalp  down  on  to  the  face;  and  (2)  a  dry- 
ness  of  the  scalp,  with  itching,  and  dry  scales,  which  accu- 
mulate on  the  collar  of  the  coat  during  the  day,  and  fall 
in  a  shower  when  the  hair  is  brushed.  The  first  variety  is 
generally  called  scurf,  and  the  second  is  named  dandruff. 
In  the  one  case  the  skin  glands  are  too  active  and  too  much 
oil  is  made,  so  that  the  skin  becomes  sodden  and  sticky,  and 
in  dandruff  the  hair,  eyebrows,  mustache  and  beard  get 
thin  because  there  is  not  oil  enough  in  the  scalp.  In  both 
cases  the  hair  glands  are  in  fault.  Constipated  persons 
seem  to  be  very  liable  to  scurf  on  the  head.  Seeing  that 
people  of  all  ages  and  of  all  classes,  and  of  every  way  of 
life,  and  under  the  most  various  circumstances  of  health 
and  quality  of  skin,  suffer  from  scurf,  we  are  sure  to  be 
pretty  right  if  we  conclude  that  scurfiness  is  caused  by  the 
presence  of  some  parasite  or  other.  But  although  animal- 
culas  of  many  different  varieties  have  been  found  in  the 
scales  from  scurfy  heads,  no  one  can  be  sure  yet  what  par- 
ticular organism  does  the  mischief.  The  importance  of 
all  this  to  a  non-medical  reader  is  this — that  no  one  ought 
to  wear  the  cap  or  hat,  or  use  the  hair  brushes  or  combs  of 
another  person,  and  that  brushes  and  combs  ought  to  be 
washed  in  disinfectants  as  well  as  with  soap.  In  the  house- 
hold of  the  intelligent  woman  of  the  present  day,  disin- 


246  SCURVY 

fectant  solutions  ought  to  be  frequently  in  use  for  the  pre- 
vention of  disease ;  for  prevention  is  better  than  cure.  As 
to  what  disinfectant  to  use,  one  may  employ  Sanitas  Fluid  . 
or  boric  acid,  or  boroglyceride,  or  carbolic  acid,  or  corrosive 
sublimate.  The  last  two  are  very  powerful,  and  they  are 
also  poisonous.  But  little  bottles  of  tablets  may  easily  be 
obtained,  and  lotions  of  various  strengths  (according  to  the 
purpose  required,  and  prepared  from  the  instructions  on 
the  labels),  may  be  made  in  a  few  minutes. 

There  is  no  doubt  but  that  scurfiness  prepares  the  way 
for  eczema  in  some  persons  and  that  it  is  sometimes  diffi- 
cult to  decide  where  scurf  leaves  off  and  eczema  begins. 
All  the  more  reason  for  keeping  brushes  and  combs  clean 
and  disinfected,  and  for  not  using  other  people's  clothes 
and  for  frequent  washing  of  the  scalp. 

Now  scurf  is  a  local  disease,  and  does  not  require  "medi- 
cines for  the  blood."  The  scaly  masses  ought  to  be  got 
away  by  gentle  rubbing  with  a  clean  rag,  dipped  in  spirit. 
Then,  at  bedtime,  in  the  case  of  dandruff,  or  dry  scurf,  rub 
into  the  scalp  (NOT  the  hair,  but  the  skin)  an  ointment  made 
of  precipitated  sulphur,  1  part  in  10  parts  of  cold  cream. 
Another  good  pomade  is  made  of  5  grains  of  precipitated 
sulphur  to  an  ounce  of  lanolin. 

In  the  other  cases  of  scurf,  where  there  is  already  too 
much  oiliness,  first  remove  all  greasy  crusts  and  scabs  and 
scales,  but  gently,  and  without  one  of  those  abominable 
little  fine-tooth  combs,  which  injure  the  skin  and  do  harm. 
Wash  the  scalp  daily  with  Spiritus  alkalinus  saponis  in 
warm  water  for  a  week  or  so.  Then  when  the  scurfiness  is 
less,  wash  only  once  a  week,  and  then  use  a  new  lotion  made 
of  20  grains  of  corrosive  sublimate  in  6  ounces  of  spirit  and 
2  pints  of  water.  This  is  a  poisonous  preparation,  and  it 
must  be  labeled  poison  and  not  left  about.  And,  at  last, 
when  there  is  no  more  scurf,  to  promote  the  growth  of  the 
hair,  use  the  following  elegant  pomade  whenever  necessary : 
— Precipitated  sulphur,  2  drachms;  castor  oil,  4  drachms; 
tincture  of  cantharides,  1  fluid  drachm ;  balsam  of  Peru,  10 
drops  or  more ;  cocoanut  oil,  3  drachms.  This  will  be  found 
a  delightful  preparation  and  may  be  continued  throughout 
life.  (For  other  methods  of  treating  Scurf,  see  "Skin  Dis- 
eases" IV.) 

Scurvy. — This  is  a  blood  disease  caused  by  the  absence  of 
sufficient  vegetables  in  the  diet.  It  is  not  to  be  confounded 


SELF-DOCTORING  247 

with  scurfiness  or  scurf,  which  is  merely  an  unhealthy  condi- 
tion of  the  scalp  of  the  head.  The  signs  of  scurvy  are — 
weakness  of  gradual  onset,  sallowness,  sunken  eyes,  pains  all 
over  the  body,  tenderness  of  the  gums,  and  foul  breath. 
Later,  the  gums  bleed,  the  teeth  fall  out  and  bleeding  takes 
place  from  nose,  rectum  or  vagina  and  even  under  the  skin 
(bruises)  and  in  the  whites  of  the  eyes.  The  disease  may 
cause  death  at  last. 

Treatment. — Scurvy  can  always  be  avoided  by  a  sufficient 
supply  of  fresh  vegetables  or  fresh  meat ;  and  the  same  rem- 
edy will  cure  all  but  the  very  worst  cases. 

Seasickness. — There  are  some  people  who,  expecting  to 
be  seasick  when  they  go  down  to  the  quay,  generally  man- 
age to  feel  so  before  they  actually  go  on  board  by  merely 
watching  the  ship  riding  at  her  anchor.  Others,  expecting 
to  be  sick,  spoil  the  whole  pleasure  and  interest  by  mere 
apprehension.  Some  require  no  more  than  the  gentle 
plunging  of  a  vessel  at  anchor ;  some  need  a  thorough  shak- 
ing-up  in  order  to  produce  retching.  As  soon  as  a  suscep- 
tible patient  gets  on  board  a  ship  he  should  lie  down  flat  on 
his  back  and  keep  his  eyes  closed,  and  try  to  get  a  nap. 
But,  then,  the  susceptible  man  or  woman  ought  never  to  at- 
tempt a  sea  voyage  without  preparing  themselves.  The 
nervous  system  of  such  a  person  requires  soothing  for  a  few 
days  before  embarkation.  Twenty  grains  of  bromide  of 
sodium  ought  to  be  taken  thrice  daily  for  four  days  before 
going  on  board.  A  light  meal  must  then  be  taken  three 
hours  before  the  ship  starts.  Some  people  only  want  a 
little  courage  to  help  them  fight  against  seasickness,  and 
iced  champagne  may  very  often  supply  the  stimulus  re- 
quired to  make  Dutch  courage.  Chlorobrom  is  one  of  the 
favorite  remedies.  It  contains  bromide  of  potash  and  other 
things,  and  should  be  taken  in  the  same  way.  Some  people 
like  to  suck  extra  strong  peppermints  all  the  time,  and 
there  is  no  objection  to  them  if  the  people  near  at  hand  do 
not  object.  Before  going  on  board  attend  well  to  the  gen- 
eral health.  Eat  nothing  in  the  least  bit  indigestible,  such 
as  pickles,  cheese,  nuts,  rich  soups,  highly  seasoned  dishes, 
and  such-like.  And,  above  all  things,  keep  the  bowels  freely 
open. 

Self-Doctoring. — This  is  only  mentioned  to  be  condemned. 
No  sensible  man  or  woman  will  doctor  himself  or  herself  in 
anything  more  than  a  passing  ailment.  Even  a  doctor  will 


248  SEWAGE  DISPOSAL 

not  doctor  himself,  because  he  knows  how  misleading  sen- 
sations can  be.  If  you  are  ill,  send  for  the  best  doctor 
you  can  afford,  and  respect  him,  and  put  full  faith  in  him. 
Tell  him  everything,  carry  out  his  full  directions  and  work 
with  him  in  every  way.  Even  at  the  worst,  his  advice, 
founded  on  skill  and  experience,  must  be  better  than  your 
unskilled  guesswork;  and  this  plan  will  be  found  to  be 
more  economical  in  the  end. 

Sewage  Disposal. — There  are  few  more  common  methods 
for  the  transmission  of  disease  than  the  improper  disposal 
of  sewage.  This  comes  about  as  a  rule  through  the  con- 
tamination, through  sewage,  of  water  and  milk  supplies, 
of  baths,  and  of  food  supplies,  largely  through  the  agencies 
of  flies.  Diseases  transmitted  in  such  ways  are  typhoid  and 
scarlet  fever,  cholera,  diphtheria,  tuberculosis,  summer 
diarrheas,  and  many  others,  including  those  due  to  the  in- 
testinal parasites.  One  of  the  gravest  and  most  familiar 
example  of  the  last  is  the  transmission  of  hook-worm 
through  sewage-contaminated  soil. 

This  is  a  foot  or  skin  infection  and  is  prevented  by  wear- 
ing shoes. 

There  are  two  main  systems  of  sewage  disposal — the  wet 
and  the  dry  systems.  The  wet  system  is  only  applicable 
where  there  is  a  plentiful  water  supply,  as  in  cities,  or  towns 
and  is  therefore  confined  to  thickly  settled  districts. 

The  methods  most  in  use  in  the  dry  system  are  the  pail 
system,  the  earth  closet  and  the  privy  vault. 

The  last  method  is  usually  objectionable  as  the  contained 
sewage  is  very  liable  to  contaminate  soil  and  water. 

If  used  it  should  be  lined  with  impervious  material  like 
concrete  or  brick  and  emptied  every  week  or  two.  It  should 
always  be  carefully  screened  from  flies  and  the  openings 
should  have  hinged  coverings. 

In  the  pail  system  a  pail  is  used  of  about  two  cubic  feet 
capacity. 

These  pails  are  removed  as  often  as  necessary — neigh- 
boring farmers  being  willing  to  remove  them  free  of  charge 
on  account  of  the  value  of  this  material  as  fertilizer. 

In  the  earth-closet  system  about  a  pound  and  a  half  of 
dry  sifted  loam  or  clay  are  immediately  thrown  upon  the 
dejecta,  which  are  thus  rendered  inodorous  and  inoffensive. 
Owing  to  the  action  of  certain  bacteria  in  the  earth,  all 
trace  of  the  peculiar  nature  of  the  organic  compound  is 


SEWAGE  DISPOSAL  249 

quickly  destroyed,  and  the  mixture  soon  becomes  practi- 
cally nothing  but  humus  and  is  of  some  value  as  a  fer- 
tilizer. 

The  closet  should  not  be  on  ground  higher  than  the  house ; 
it  should  be  tightly  closed  in  and  the  openings  in  the  seat 
covered  to  keep  out  the  flies.  It  should  not  be  too  far  from 
the  house  (about  150  feet)  and  not  nearer  to  a  well  than  200 
feet.  Lime  should  be  freely  used,  or  even  better  are  wood 
ashes.  Closets  should  be  frequently  cleaned  and  the  matter 
in  them  (if  not  used  for  fertilizing  purposes)  completely 
buried  or  spread  out  on  soil  at  some  distance  from  the  house 
so  that  it  will  dry  quickly. 

Horse  manure  is  best  handled  by  placing  immediately  in 
barrels  which  are  covered  or  screened  from  flies  (98  per 
cent,  of  which  breed  in  horse  manure). 

In  the  wet  system  of  sewage  disposal  the  chief  points  of 
interest  are  the  collection  or  plumbing  and  the  disposal  of 
the  sewage  material. 

The  essentials  of  good  plumbing  are: — 

Enough  water  to  flush  and  clean  pipes. 

A  ventilation  system  to  dilute  and  carry  off  gases. 

Open  plumbing — to  facilitate  examination  and  repairs. 

Traps — to  prevent  entrance  of  sewer  gas  and  micro- 
organisms into  the  dwelling. 

The  following  are  the  commoner  methods  of  sewage  dis- 
posal, which  concern  not  so  much  the  householder  as  the 
engineer  planning  city  works: — 

Emptying  into  the  sea  at  a  distance  from  the  shore. 

Land  irrigation,  in  which  the  sewage  is  distributed  over 
farms  for  fertilizing  purposes. 

Purification  by  chemical  precipitation  with  subsequent 
disposal  of  the  sludge. 

Biological  purification  by  means  of  the  septic  tank  or 
contact  beds. 

Filtration. — This  is  often  combined  with  the  previous 
method.  The  filtrate  contains  very  few  bacteria  after  the 
last  three  processes  and  may  safely  be  emptied  into  a  large 
stream. 

To  empty  untreated  sewage  into  a  stream  is  criminal,  as 
inhabitants  on  the  banks  lower  down  are  certain  to  con- 
tract such  diseases  as  typhoid  fever,  diphtheria  or  cholera 
if  this  water  is  drunk. 

Cesspools,  which  are  frequently  used  in  the  country  to 


250  SIMPLE  LIFE 

temporarily  collect  and  store  large  amounts  of  sewage,  are 
dangerous  unless  properly  built. 

They  should  be  at  least  50  feet  away  from  a  dwelling  and 
60  to  80  feet  distant  from  a  well,  spring  or  stream.  Their 
walls  and  floors  must  be  constructed  of  good  brickwork  in 
cement,  rendered  inside  with  cement,  and  with  a  backing 
of  at  least  9  inches  of  well-puddled  clay  around  and  beneath 
the  brickwork.  The  top  of  the  cesspools  must  be  arched 
over  and  means  of  ventilation  provided,  which,  at  the  same 
time,  are  carefully  screened  from  flies  and  insects. 

The  best  method  of  emptying  cesspools  is  by  the  pneu- 
matic pressure  method  such  as  is  commonly  used  in  Paris 
with  the  fosse  permanente. 

Simple  Life,  The. — The  papers,  a  short  while  ago,  were 
full  of  this  expression:  "Live  the  Simple  Life!"  What 
does  it  mean?  "The  Simple  Life"  is  the  title  of  a  won- 
derful book  by  a  German  pastor  named  Wagner,  in  which 
he  finds  just  fault  with  all  the  artificiality  of  our  present 
empty  civilization.  He  shows  that  most  of  the  so-called 
comforts  we  enjoy  are  not  necessaries,  but  luxuries  which 
we  should  be  happier  without.  Who  can  doubt  it?  The 
arguments  in  this  book  chiefly  hit  the  foolish  expenses  of  a 
certain  rich  class;  but  the  working  man  is  not  exempted, 
for  does  he  not  drink  to  the  hurt  and  damage  of  his  health 
and  happiness,  the  emptying  of  his  purse,  and  the  impov- 
erishment of  his  family?  What  would  life  be,  with  all  its 
disappointments,  without  some  of  its  convivial  drinking,  its 
smoking,  its  cups  of  tea? — the  reader  may  ask.  Well,  as 
life  is  at  present  in  our  towns,  and  with  the  fearful  com- 
petition, life  would  be  dull  indeed  without  some  "dissipa- 
tion," we  are  forced  to  admit.  But,  all  the  same,  the  Sim- 
ple Life  has  its  claims  upon  us.  It  does  not  mean  that 
to  be  happy  and  well  we  ought  to  forego  all  alcohol,  all  tea, 
all  tobacco,  all  gorgeous  hats,  smart  boots  and  shoes, 
feathers  and  luxuries. 

It  only  means  that  the  man,  woman,  or  child  is  happy 
and  rich  in  proportion  to  the  things  he  or  she  can  do  with- 
out! The  more  simply  we  live,  the  happier  and  healthier 
we  shall  be.  The  real  Gospel  of  the  Happy  Life  is  to  learn 
to  do  without.  We  do  need  pictures,  and  travel,  and  books, 
and  clothes,  and  stimulants,  in  moderation.  They  help  us 
to  develop  the  best  that  is  in  us.  But  we  can  and  ought  to 
see  pictures  in  the  galleries,  and  they  are  better  than  most 


SINS  AGAINST  HEALTH  251 

of  us  can  buy;  we  can  spend  our  savings  on  bicycles  and 
traveling  tours ;  we  can  dress  suitably  to  our  stations,  and 
for  comfort  rather  than  show ;  and  we  only  need  stimulants 
when  we  are  not  strong  enough  for  the  work  we  have  to  do. 
The  Simple  Life  saves  our  pocket  money,  and  increases  our 
health  and  enjoyment.  We  are  better  citizens,  better  sons 
and  daughters,  better  sweethearts,  better  married  folk,  bet- 
ter fathers  and  mothers,  better  old  people,  for  having 
learned  to  do  without  what  we  really  do  not  need.  It  is  in 
the  hands  of  women,  to  a  great  extent,  to  bring  into  effect 
the  advantages  to  be  gained  by  the  simpler  way  of  living. 
Let  them  scorn  to  keep  company  with  the  man  who  drinks 
to  excess,  and  let  them  refuse  to  marry — as  they  are  doing 
more  and  more — with  men  who  are  dissipated  or  selfish  and 
luxurious.  And  they  themselves  may  set  a  good  example 
by  dressing  plainly,  and  discouraging  extravagance.  They 
are  very  anxious  to  please  and  be  pleasing ;  so  let  the  men, 
in  their  turn,  discourage  over-fine  dressing,  excessive  tea- 
drinking,  and  encourage,  as  far  as  possible,  the  "Simple 
Life"  in  their  families. 

Sins  against  Health — Hygienic  Misdemeanors. — Under 
these  rather  stern  titles  we  refer  to  all  those  faults 
which  people  commit,  knowingly  or  unknowingly,  against 
their  physical  bodies  or  their  minds.  How  is  it  that  to-day 
there  is  a  mighty  host  of  doctors  trying  to  grapple  with  a 
mass  of  disease  and  ill  health;  that  there  are  hundreds  of 
patent  medicines,  all  guaranteed  to  cure;  that  there  is  an 
ever-increasing  number  of  asylums  for  the  unfortunate  in- 
sane; and  that  every  year  the  hospitals  are  crying  out  for 
funds,  that  they  may  enlarge  the  scope  of  their  necessary 
labors?  Is  not  medical  science  wonderfully  advanced? 
Have  we  not  sanitary  boards,  health  officers,  splendid  san- 
itation, and  isolation  of  infectious  disease?  How  many 
families,  reader,  do  you  know  of  in  which  there  is  no  one 
sick,  no  one  ever  ailing?  Has  nearly  every  family,  then,  a 
sick  member?  And  this  in  America — the  most  advanced, 
civilized,  and  enlightened  country  in  the  wide  world  (ac- 
cording to  the  American)  !  The  fact  is,  that  we — advanced, 
wealthy,  sensible,  sturdy,  plucky,  enlightened  and  civilized, 
as  we  are — are  living  to-day  an  artificial,  unwholesome, 
and  wearing  life ;  and  it  is  the  artificiality  of  our  lives  that 
prevents  so  many  of  us  from  enjoying  the  birthright  of 
every  living  creature — sound  health.  As  long  as  an  indi- 


252  SKIN  DISEASES 

vidual  follows  that  inward  voice  which  tells  him  what  to 
do  and  what  not  to  do,  he  remains  healthy  in  body  and 
mind.  As  soon  as  he  begins  to  hear  and  do  what  others  tell 
him  to  do,  he  begins  to  find  life  complex,  and  to  ail  some- 
thing. A  young  man  is  led  to  suppose  something  manly 
in  drinking  and  smoking;  of  himself,  unless  he  be  ill,  he 
would  never  drink  except  when  thirsty;  and  of  himself  he 
probably  would  never  smoke.  Why  should  he?  He  only 
smokes  in  imitation  of  his  fellows.  The  young  girl  is  told: 
that  to  tight-lace,  wear  high  heels,  or  otherwise  deform  her- 
self is  to  excite  admiration  in  men.  Of  herself  she  would 
probably  prefer  to  breathe  freely,  and  to  live  without  adorn- 
ment other  than  the  roses  of  good  health.  Thus  you  see 
what  we  mean  by  a  hygienic  misdemeanor — it  is  really  a  sin 
against  health.  You  must  realize  that  Nature  is  pitiless 
and  inevitable ;  that  as  you  sow,  so  must  you  reap.  Every 
excess  must  be  followed  by  a  reaction,  a  depression;  every 
sin  brings  its  own  punishment,  sooner  or  later — but  sure  as 
death.  No  one  can  escape  this  law.  And,  in  the  same  wayr 
it  is  possible  to  live  righteously,  from  a  hygienic  point  of 
view — to  be  moderate,  temperate  in  eating,  as  well  as  in 
drinking,  and  the  result  is  just  as  certain,  just  as  inevitable. 
Years  of  drinking  to  excess,  whether  in  the  bar  or  in  the 
privacy  of  your  bedroom,  with  the  bottle  hidden  beneath 
the  mattress  or  up  the  chimney — will  tell  upon  you,  ruin 
your  nerve,  and  spoil  your  health.  And  years  of  moderate 
living,  of  hard  work,  of  early  hours,  and  of  exercise  in 
fresh  air,  will  have  their  due  effect.  Without  accidents 
or  excesses  many  a  man  and  woman  lives  to  a  hale  and. 
hearty  hundred.  Why  not  you? 

Skin  Diseases. — I. — This  is  a  subject  which  does  not  lend 
itself  to  easy  comprehension  by  the  non-medical  person. 
More,  perhaps,  than  in  any  other  branch  of  medicine  is  it 
necessary  to  know  the  anatomy  and  physiology  of  the  parts 
under  consideration,  and  to  have  experience  of  hundreds 
of  cases.  We  have,  therefore,  merely  written  a  sketch  of 
the  subject  here,  while  for  a  few  only  of  the  commonest  skin 
diseases  and  their  remedies,  details  are  given  under  sepa- 
rate headings  (which  see). 

Almost  all  persons  have  some  form  of  skin  disease  at  one 
time  or  another,  and  these  affections  often  give  rise  to  muck 
discomfort  and  often  to  disfigurement.  Some  forms  cause 


SKIN  DISEASES  ?53 

great  irritation,  others  are  painful,  and  some  give  rise  to 
unpleasant  discharges. 

It  must  be  remembered  that  many  skin  ailments  are  con- 
tagious, especially  those  that  are  due  to  parasites  or  insects. 
Some  are  attended  by  fever,  and  these  are  acutely  infec- 
tious, such  as  measles  and  scarlatina. 

Some  of  these  diseases  are  only  observed  in  infancy,  others 
in  childhood,  while  others  again  are  only  seen  in  middle  life 
or  in  aged  persons. 

Constitutional  diseases  of  the  nature  of  blood-poisoning 
are  often  shown  to  exist  by  skin  eruptions.  The  diseases 
of  the  skin  are  shown  by  about  nine  different  peculiarities 
of  the  surface ;  these  may  occur  singly  or  may  be  observed 
grouped  together.  These  forms  are  smooth  reddened 
blushes,  pimples,  vesicles,  blebs,  pustules,  wheals,  stains, 
scaliness,  or  scabs. 

For  example,  erysipelas  is  shown  by  a  blush  only,  but 
smallpox  goes  through  the  stages  of  pimple,  vesicle,  pustule, 
and  scab ;  while  psoriasis  is  scaly  only,  as  is  one  form  of 
ringworm  or  tetter.  The  red  blush  is  seen  in  measles  or 
scarlatina.  By  pimple  is  meant  a  small,  round,  raised  spot, 
somewhat  hard  and  solid.  A  vesicle  is  a  similar  spot,  which 
contains  a  drop  of  clear  liquid.  A  pustule  is  a  similar 
raised  spot,  containing  a  drop  of  pus,  or  matter — a 
thick  yellow  liquid.  Blebs  are  large  vesicles  like  a  blister 
caused  by  a  scald  or  burn.  Wheals  are  temporary  raised 
pink  patches;  they  rarely  last  many  hours;  they  are  seen 
after  nettle  stings. 

Scales  of  dry  scurf  are  commonly  seen  on  the  scalp,  but 
some  skin  diseases  cause  large  patches  of  scaly  soreness  on 
the  hands  and  arms.  Stains  of  color,  which  are  often  hairy, 
are  generally  formed  before  birth,  but  some  patches  of  yel- 
low or  brown  color  may  be  due  to  parasites  in  the  skin,  or 
some  are  caused  by  constitutional  disease. 

Scabs  are  the  late  stage  of  vesicles,  blebs,  and  pustules, 
after  they  have  been  broken,  and  arise  from  the  surface  dry- 
ing into  a  hardened  crust;  but  when  a  scab  is  pulled  off 
a  raw  sore  place  is  found  underneath. 

Scabs  being  a  dried,  dead  layer,  it  is  not  of  the  slightest 
use  to  apply  any  ointment  or  lotion  to  them;  the  scabs 
must  be  removed,  and  any  curative  treatment  must  be  ap- 
plied to  the  raw  surface.  Much  disappointment  is  often 


254  CHILBLAINS 

felt  by  a  neglect  of  this  precaution.  To  remove  scabs  it  is 
often  necessary  to  apply  one  or  more  poultices  of  bread, 
linseed  meal,  or  mashed  boiled  turnip. 

II. — Chilblains,  Cracks  and  Chaps. — One  of  the  most 
common  forms  of  skin  disease  in  the  cold  weather  is  the 
chilblain;  this  is  caused  by  exposure  to  cold  air,  and  is 
often  due  to  imperfect  drying  of  the  hands  after  washing 
them ;  it  also  attacks  the  feet,  and  in  some  persons  the  ears 
suffer  from  exposure  to  cold  winds.  What  are  called  chaps 
are  also  caused  by  cold.  Persons  afflicted  with  a  weak  con- 
stitution and  a  defective  circulation  of  the  blood  suffer 
most  often. 

Chilblains  commence  with  a  red  blush  on  the  skin,  which 
is  very  irritable,  and  becomes  tender  from  rubbing.  If 
they  are  not  soon  cured  they  are  apt  to  become  broken  in 
small  patches;  that  is  to  say,  the  inflamed  surfaces  become 
raw,  and  require  to  be  treated  as  an  ulcer  with  healing 
applications,  such  as  zinc  ointment.  While  unbroken  they 
need  to  be  protected  from  the  air,  and  require  stimulating 
liniments  or  spirituous  paints,  such  as  the  tincture  of 
iodine.  An  excellent  application  is  made  by  mixing 
turpentine  12  parts,  castor  oil  6  parts,  and  collodion  30 
parts ;  this  is  painted  on  the  chilblains  with  a  brush.  Com- 
pound soap  liniment  or  camphor  liniment  will  cure  many 
cases.  A  favorite  old  domestic  remedy  was  to  take  an 
onion,  cut  it  in  half,  dip  it  in  salt,  and  rub  the  salted  cut 
surface  on  the  chilblains.  None  of  these  applications  must 
be  put  on  a  broken  chilblain.  Inasmuch  as  this  ailment 
shows  a  state  of  feeble  health,  it  is  always  wise  to  give 
cod-liver  oil  for  two  or  three  weeks  after  meals  and  also 
to  take  a  mixture  of  quinine  and  iron  half  an  hour  before 
the  two  principal  meals  each  day. 

Chaps  and  small  cracks  on  the  skin  of  the  fingers  may 
be  well  treated  by  collodion,  or  by  the  above-described  col- 
lodion paint.  Chafes  are  red  patches  of  skin  due  to  rub- 
bing, and  are  also  frequently  found  on  the  legs  of  infants, 
where  they  are  set  up  by  their  being  kept  tied  up  in  wet 
napkins,  especially  if  they  are  not  changed  often  enough. 
These  can  be  avoided  by  frequent  bathing  with  warm  water 
and  soap,  and  the  parts  carefully  dried  with  a  warm,  soft 
towel.  When  they  have  occurred  they  must  be  carefully 
attended  to  in  the  same  manner,  and  then  dusted  over  with 
a  mixture  of  dry  oxide  of  zinc  and  starch  powder.  If 


NETTLERASH  255 

actual  soreness  has  arisen,  then  apply  zinc  ointment  twice 
a  day,  and  put  a  layer  of  clean  lint  smoothly  over  the  part. 
Fuller's  earth  is  often  applied  by  the  poor  to  these  tender, 
sore  patches  on  infants,  but  it  often  does  harm,  because 
it  is  not  ground  sufficiently  fine  and  smooth.  Another 
excellent  dusting  powder  is  named  oleate  of  zinc;  it  is 
extremely  soft,  and  very  soothing  to  inflamed  skin. 

III. — Nettlerash,  Freckles,  Babies'  Pimples,  Erythema. 
— The  ailment  called  nettlerash  is  not  uncommon;  it  is  al- 
most always  due  to  indigestion  set  up  by  excess  of  food, 
or  by  unwholesome  food,  and  attacks  are  particularly  com- 
mon after  eating  shellfish,  crabs,  lobsters,  cockles,  oysters, 
or  periwinkles.  Eating  cold  pickles  with  hot  meat  is  an- 
other cause.  A  sudden  chill  on  a  perspiring  skin  may 
bring  it  on.  Persons  who  have  had  one  attack  often  have 
others  subsequently.  Nettlerash  is  a  red  blush,  upon  which 
a  paler  patch  soon  appears;  it  does  not  last  many  hours, 
but  leads  to  much  itching  and  irritation.  Scratching  and 
rubbing  this  part  should  be  avoided,  and  the  irritation  can 
be  subdued  by  lead  lotion,  zinc  ointment,  or  by  a  lotion 
of  equal  parts  of  sanitas  and  water.  Epsom  salts,  taken 
in  water,  is  the  best  remedy  for  internal  use. 

Freckles  are  a  form  of  skin  disease,  shown  by  small  yel- 
low or  brown  spots  on  the  white  skin  of  the  face,  arms  and 
hands.  Most  persons  object  to  them,  but  there  are  a  few 
people  who  do  not  think  them  unbecoming.  There  are 
hundreds  of  advertised  quack  remedies  for  freckles,  but  we 
do  not  consider  that  there  is  any  means  of  cure.  They 
often  come  out  after  exposure  to  bright,  hot  sunlight,  and 
may  disappear  of  themselves.  The  cucumber  ointment  im- 
ported from  Paris  is,  perhaps,  the  most  likely  means  of 
cure.  Or  the  following  lotion  may  be  tried : — Fresh  lemon- 
juice,  rose-water,  rectified  spirit — equal  parts.  (Mix.) 
Leave  for  24  hours.  Strain  through  muslin.  Bathe  the 
face  night  and  morning  with  the  lotion  after  washing,  and 
dry  lightly. 

Red-gum  and  white-gum  are  the  names  of  minute  red 
or  white  pimples  seen  on  the  skin  of  infants ;  they  appear 
after  free  perspiration  under  their  clothing;  they  are  not 
of  much  importance  and  do  not  last  many  days.  A  little 
laxative  medicine  may  be  given,  and  lead  lotion  or  zinc 
ointment  may  be  applied  to  the  skin. 

The  group  of  pink,  red,  and  purple  skin  rashes,  which 


256  SCALP  DISEASES 

are  accompanied  by  fever — we  refer  to  measles,  scarlatina, 
and  erysipelas — are  serious  diseases,  and  need  medical  care. 
There  is  one  other  which  may  not  be  of  much  importance ; 
this  is  called  Erythema.  In  this  disease  there  may  be  no 
fever,  and  it  is  shown  by  the  appearance  of  roundish  pink 
patches  on  the  white  skin,  and  these  are  often  seen  on  the 
front  of  the  legs.  They  may  be  a  little  raised  above  the 
skin  around  them;  they  may  become  more  dusky  in  color 
as  they  fade  away;  they  last  a  few  days.  These  patches 
are  also  seen  on  the  face  and  chest.  The  treatment  is  by 
aperient  medicines,  such  as  sulphate  of  soda  or  sulphate  of 
magnesia,  citrate  of  magnesia,  or  the  tartarated  soda;  rhu- 
barb, with  bicarbonate  of  soda,  is  suitable  for  children  and 
infants.  The  diet  for  a  few  days  must  be  light,  consisting 
of  broths  and  farinaceous  puddings,  and  fruit;  lemonade 
is  the  best  drink  to  be  taken.  This  skin  rash  is  not  con- 
tagious. 

IV. — Scalp  Diseases. — The  skin  of  the  head  is  a  part 
which  often  gives  rise  to  trouble.  In  health  it  should  be 
pale,  smooth,  free  from  scurf,  and  not  too  greasy,  and  the 
hairs  should  stick  firmly  in  it. 

In  disease  it  loses  all  these  natural  characters.  The  hair 
may  fall  out  generally,  or  in  patches,  and  leave  baldness. 
There  may  be  any  variety  of  pimples,  and  pustules  with 
scabs,  and  the  scalp  may  become  scurfy,  with  either  dry- 
scales  or  a  matted  greasiness.  Some  forms  are  acutely 
contagious;  others  cannot  be  caught  by  one  persons  from 
another. 

Loss  of  the  hair  may  be  due  to  ill  health,  and  may  result 
from  the  violence  of  a  fever,  and  the  hair  does  become 
gradually  thinner  during  consumption  and  chronic  ill- 
nesses. In  such  cases,  when  recovery  follows,  the  hair 
generally  takes  on  new  growth.  Loss  of  hair  early  in  life 
is  very  often  an  inherited  peculiarity,  and  in  such  persons 
neither  medicines  nor  local  applications  will  effect  a  cure. 
When  the  loss  of  hair  occurs  in  patches  it  becomes  neces- 
sary to  decide  whether  the  baldness  is  due  to  the  growth 
of  a  microscopic  vegetable  mold,  or  fungus,  or  to  some  fault 
in  the  nerves  of  the  spot.  To  decide  this  a  physician  is 
necessary;  he  must  scrape  the  surface,  and  examine  the 
scurf  under  powerful  glasses ;  if  there  is  any  mold  growth, 
the  treatment  is  by  applications  which  kill  such  fungi;  if 
not,  the  cure  is  by  stimulating  liniments  and  general  tonics. 


RINGWORM  257 

Scurfiness  of  the  scalp  is  often  a  great  annoyance;  it 
generally  comes  on  from  neglect  of  regular  washing  of  the 
scalp  and  brushing  of  the  hair.  Local  treatment  is  neces- 
sary. The  scalp  must  be  thoroughly  washed  with  warm 
water,  with  a  nailbrush  and  a  cake  of  10  per  cent,  carbolic 
soap,  which  a  chemist  can  supply.  Do  this  every  other 
night,  three  times.  After  this  treatment,  rub  in  every 
night  the  following  lotion,  with  a  piece  of  flannel : — Mix  the 
yolk  of  a  small,  fresh  egg  with  half  an  ounce  of  spirit  of 
rosemary,  and  a  half-pint  of  clean  rain  water.  "When  the 
scurf  is  greasy,  rub  in  this  lotion  instead: — Take  one 
drachm  each  of  powdered  bicarbonate  of  soda,  and  borax, 
half  an  ounce  of  eau-de-cologne,  one  ounce  of  rectified 
spirit,  and  water  half  a  pint ;  mix  and  bottle. 

Until  lately  it  was  considered  very  good  practice  to  rub 
pomatums,  scented  ointments,  into  the  scalp  almost  daily, 
but  of  late  years  doctors  have  considered  that  this  custom 
chokes  up  the  pores  of  the  skin,  and  does  not  nourish  the 
hair.  The  present  plan  is  to  stimulate  the  growth  of  the 
hair  by  constant  brushing  of  the  hair  and  scalp. 

V. — A  note  on  Ringworm. — We  come  now  to  that  most 
persistent  and  troublesome  ailment  which  is  commonly 
called  tetter,  or  ringworm.  It  is  a  contagious  disease,  due 
to  the  growth  of  a  minute  vegetable  mold  or  fungus  on  the 
skin,  and  in  the  roots  of  the  hairs.  It  makes  the  hairs 
brittle,  and  they  break  off,  and  makes  them  loose,  and  they 
fall  out.  The  disease  may  commence  in  one  spot  only,  or 
in  many  patches,  almost  at  once.  It  causes  irritation,  and 
so  the  sufferer  scratches  it,  and  so  makes  the  skin  red  and 
inflamed,  and  he  infects  one  place  after  another.  Patches 
may  begin  anywhere  among  the  hair  on  the  scalp,  or  on 
the  neck  where  there  is  only  a  fine  down  growing.  There 
is  a  variety  of  ringworm  which  occurs  on  the  skin  of  the 
face,  neck,  arms,  or  body  where  there  is  no  hair;  this  also 
is  parasitic,  but  it  is  much  less  troublesome  and  is  gen- 
erally easily  cured  by  the  ointment  of  ammoniated  mer- 
cury. The  difficulty  with  children  is  to  prevent  them 
scratching  the  spots,  and  so  spreading  the  disease. 

To  return  to  ringworm  of  the  scalp,  if  you  see  a  patch 
of  about  a  week  old  which  has  not  been  treated  there  will 
be  a  bare  place,  with  a  scurfy  pink  surface,  the  stumps 
of  the  hairs  visible;  a  few  hairs  not  yet  lost  will  be  found 
to  be  easily  broken  off  by  rubbing  them;  such  a  patch  be- 


258  RINGWORM 

comes  red  with  scratching,  and  may  soon  be  covered  with 
vesicles  and  little  scabs ;  ointments  and  paints  which  cause 
irritation  will  produce  the  same  result.  The  patch  may 
spread  continuously,  or  other  separate  patches  may  appear, 
and  any  or  all  of  them  may  spread,  until  almost  all  the 
hair  of  the  head  has  been  destroyed. 

If  a  child  be  very  healthy,  and  if  the  first  patch  be  at 
once  treated  in  a  scientific  manner,  there  may  be  a  chance 
of  cure  in  a  month  if  there  be  no  infection  of  other  spots. 

But  in  the  majority  of  cases  the  disease  spreads  from  its 
first  center  and  may  run  a  course  of  many  months,  and 
even  years. 

In  order  to  effect  a  cure  it  is  necessary  to  improve  the 
general  health,  to  keep  the  spots  free  from  dried  scabs, 
to  apply  paints  or  ointments  which  will  kill  the  growth, 
and  then,  with  zinc  or  lead  ointments,  to  heal  up  the  in- 
jured surfaces.  The  most  difficult  part  is  to  find  out  when 
the  disease  is  killed,  and  the  powerful  applications  may  be 
safely  discontinued.  If  they  are  applied  too  long,  they  set 
up  unnecessary  inflammation,  ulceration,  and  scabbing;  if 
they  are  left  off  too  soon,  the  work  of  killing  the  fungus 
growth  has  to  be  begun  again.  Skilled  medical  attention 
is  necessary  throughout  the  whole  course  of  treatment. 
Amateur  doctoring  is  practically  useless.  "We  give  a  few 
good  prescriptions  for  those  who  care  to  try  them. 

(1)  For  ringworm  of  the  body. — Ointment  of  the 
iodide  of  sulphur,  y±  drachm  to  1  ounce  of  benzoated 
lard.     (For  delicate  skins.) 

(2)  For  ringworm  of  the  body — (for  farm  laborers, 
etc.). — Ointment  of  the  iodide  of  sulphur,  1  part;  lard, 
8  parts.     (Should  be  made  up  a  few  days  before  re- 
quired.) 

(3)  For  scalp  ringworm — delicate  skins. — Oleate  of 
mercury  ointment,  10  per  cent. 

(4)  Pomade  for  the  heads  of  children  in  a  school  or 
home  where  ringworm  has  broken   out. — Boric   acid 
ointment,    2   ounces;    eucalyptus   ointment,    1    ounce; 
cocoanut  oil,  2  ounces ;  oil  of  cloves,  %  drachm. 

(5)  Hutcliinson's  plan. — Cut  off  all  the  hair  and 
shave  it  close,  where  possible.     Wash  the  scalp  twice 
a  week  with  a  lotion  made  of  tar  water,  1  drachm; 
rain   water,    1    pint;    and   rub   in   this    ointment: — 


SLEEP  259 

Chrysarobin,  1  drachm ;  ammon.  hyd.  chlor.,  25  grains ; 
lanolin,  1  drachm;  benzoated  lard,  6  drachms;  tar 
water,  10  drops. 

The  secret  of  success  often  lies  in  the  patient  con- 
tinuance of  the  same  remedy. 

Sleep,  Hints  on  Obtaining. —  (1)  Let  the  room  be  well- 
ventilated  and  cool. 

(2)  Let  the  feet  be  warm.     Those  who  suffer  from  cold 
feet  should  first  try  holding  them  in  a  basin  of  cold  water 
by  the  bedside,   just  before  getting  into   bed,   for  about 
two  minutes  or  less,   and  then  rubbing  them  fairly  dry 
with  a  rough  towel.     In  persons  with  poor  circulation,  this 
plan  may  fail ;  then  a  hot-water  bottle  must  be  kept  at  the 
end  of  the  bed.     Anything  rather  than  cold  feet. 

(3)  If   hot   when   coming   to   bed,    sit   undressed   long 
enough  to  get  moderately  cool,  and  then  get  quietly  into 
bed. 

(4)  Have  nothing  to  eat  or  drink  for  at  least  two  hours 
before  bedtime. 

(5)  Once  in  bed,  resolve  to  have  done  with  thinking  and 
calculating.     Once  the  bad  habit  of  reviewing  the  day's 
actions  and  events  in  bed  is  formed,  it  is  very  hard  to 
break. 

(6)  Get  a  dark  blue  globe  for  a  night  light  or  electric 
light  in  the  bedroom.     Many  persons  can  go  to  sleep  better 
in  blue  light  than  in  any  other,  or  in  darkness. 

(7)  Try  drinking  half  a  pint  or  more  clean  cold  water 
on  retiring.     With  some  people  this  clears  the  blood,  washes 
irritating  food  out  of  the  stomach,  and  promotes  a  feeling 
of  quietude  which  helps  sleep. 

(8)  Brush  the  teeth,  and  wash  out  the  mouth  before 
retiring. 

(9)  The   following  method,   suggested  by   Mr.   Martyn 
Westcott,  may  prove  as  useful  as  it  is  interesting.     "Lie 
on  the  back,  in  an  attitude  of  complete  muscular  relaxa- 
tion.    Let  the  feet  be  warm  or  make  them  so  with  a  hot- 
water  bottle.     Let  the  covering  be  of  blankets  only,  and 
not  too  many  either;  it  is  the  lower  half  of  the  body  which 
especially  needs  to  be  kept  warm  at  night.     Now  take  a 
long  slow  breath,  without  great  effort  and  without  hurry. 
At  the  same  time  slowly  and  gradually  open  the  eyes  to 
the  full  extent.    At  the  end  of  the  long  breath  the  eyes 


260  SLEEPLESSNESS 

ought  to  be  widely  open  and  the  eyeballs  looking  upwards. 
During  these  breaths  the  mind  must  be  concentrated  on 
what  you  are  doing;  that  is  essential.  Five  such  breaths 
are  to  be  taken — leisurely,  easily — and  the  opening  and 
shutting  of  the  eyes  must  keep  time  with  them.  Then  take 
ten  such  breaths  with  the  eyes  closed.  Then  five  more 
with  the  'eye  accompaniment';  then  ten  more  without  it. 
Gradually  you  feel  more  and  more  sleepy,  you  lose  count, 
you  do  the  eye-opening  at  last  only  in  imagination,  and 
you  drop  off  to  sleep.  A  very  little  practice  is  required 
to  perfect  this  method,  which  is  really  one  of  auto-sugges- 
tion." 

Sleeplessness. — It  is  during  natural  sleep  that  the  waste 
and  wear  and  tear  of  the  mind  and  body  are  replaced  and 
remedied.  The  brain  it  is  which  controls  the  whole  organ- 
ism, and  it  is  the  brain  which  knows  when  fatigue  has 
arrived  and  when  the  various  parts  of  the  body  have  done 
as  much  work  as  they  are  fit  for.  It  is  the  activity  of  the 
brain  which  requires  rest  and  renewal,  and  if  that  activity 
is  obliged  to  continue,  if  we  are  kept  awake  too  long,  the 
whole  body  suffers.  Whereas,  as  soon  as  the  activity  of 
the  brain  ceases  for  a  time  during  sleep,  all  the  rest  of  the 
body  is  able  to  repair  and  renew  itself.  Thus  we  see 
the  importance  of  sleep.  When  we  dream  it  means  that 
only  part  of  the  brain  is  asleep,  and  that  is  why  dreamy 
sleep  is  so  unrefreshing.  That  is  the  reason  also  why 
dreams  are  so  unreasonable,  so  unhappy,  or  so  absurd ;  only 
a  small  part  of  the  brain  is  at  work,  and  there  is  no  control 
over  the  ideas  as  they  dart  in  and  out  of  the  half -conscious 
mind. 

Want  of  sleep  for  long  periods  is  often  the  cause  of  mad- 
ness; or  in  many  cases  it  would  be  true  to  say  that  the 
cause  of  madness  is  also  the  cause  of  the  sleeplessness,  and 
that  if  we  cannot  relieve  the  latter  the  patient  may  go  mad 
at  last. 

It  follows  that  we  should  make  sure  of  our  due  allowance 
of  sleep,  and  a  small  allowance  will  do  for  many  people; 
too  much  sleep  makes  one  drowsy  and  dull-witted.  We 
should  never  take  sleeping  draughts  if  there  is  any  other 
way  of  dealing  with  the  trouble.  The  principal  causes  of 
want  of  sleep  are  worry,  grief,  exciting  passions,  indiges- 
tion, heart  disease,  pain,  cold  feet,  lack  of  nourishment. 

We  are  often  asked  how  much  sleep  should  be  taken. 


SLEEPLESSNESS  261 

But  we  cannot  answer  the  question.  Every  person  must 
find  out  for  himself  how  much  sleep  he  needs,  and  see  that 
he  gets  it,  even  if  it  means  curtailing  hours  of  pleasure 
spent  in  dancing  or  amusement.  "Six  for  a  man,"  they 
say,  ''seven  for  a  woman,  and  eight  for  a  child."  But 
most  men  want  more  than  six  hours. 

Sleep  is  produced  by  withdrawing  blood  from  the  head. 
We  mean,  for  instance,  by  putting  hot-water  bottles  to  the 
feet.  Many  people  cannot  sleep  because  their  feet  are  cold 
and  bloodless. 

If  you  eat  a  hearty  meal  you  will  probably  feel  drowsy 
after  it,  and  that  is  because  the  stomach  requires  all  the 
blood  it  can  get  to  help  to  deal  with  the  food.  You  cannot 
do  brain  work  after  a  hearty  meal  because  of  this,  and  if 
you  attempt  it  you  will  get  indigestion. 

If  you  suffer  from  sleeplessness,  then,  the  first  thing  to 
do  is  to  see  if  you  are  transgressing  any  of  the  ordinary 
laws  of  health  and  hygiene.  Attend  to  the  ventilation  of 
your  bedroom;  do  not  eat  heavy  suppers,  with  pickles  and 
cheese;  take  enough  exercise  and  try  and  put  aside  all 
business  worries  as  soon  as  you  enter  the  bedroom. 

A  hard  bed  is  always  better  than  a  soft  one;  a  spring 
mattress  is  the  best  of  all  for  health;  perfect  quiet  is  not 
always  desirable ;  some  people  cannot  get  off  to  sleep  with- 
out a  clock  ticking  in  their  neighborhood;  but  habit  is  all- 
important.  Reading  in  bed  is  not  to  be  encouraged;  it 
promotes  slovenly  habits  of  mind,  though  many  sleepless 
people  read  in  bed  to  prevent  their  too  active  brains  from 
thinking  and  worrying.  It  would  be  better  to  get  out  of 
bed  and  read  at  a  table  until  too  tired  to  sit  up  any  longer. 
A  copious  drink  just  before  retiring  will  sometimes  pro- 
mote sleep ;  with  some  people  a  hot  drink,  and  with  others 
a  cold  one. 

Many  people  go  to  sleep  at  once  on  retiring,  and  then, 
after  an  hour  or  two,  wake  up  and  lie  tossing  and  restless 
until  nearly  morning.  This  is  very  often  due  to  an  un- 
suitable or  indigestible  supper,  and  will  come  right  of  itself 
as  soon  as  the  dieting  is  set  right;  but  it  may  be  due  to 
a  lack  of  nourishment,  and  then  a  few  biscuits  and  a  glass 
of  milk  taken  in  the  night  on  waking  will  lead  to  a  refresh- 
ing sleep.  As  to  the  drugs  and  medicines  which  counter- 
act sleeplessness,  in  each  case  which  will  not  yield  to  simple 
measures  medical  advice  must  be  sought.  The  fear  of  ere- 


262  SMALLPOX 

ating  a  habit  which  will  enslave  the  sleepless  one  for  the 
rest  of  his  life  will  be  enough  to  deter  unskilled  persons 
from  recommending  drugs  for  want  of  sleep.  (See  also 
"Insomnia.") 

Smallpox. — This  disease  is  always  and  only  caused  by 
contagion;  it  is  impossible  for  anyone  to  contract  small- 
pox without  coming  into  personal  contact  with  someone 
who  has  the  disease  already,  or  with  clothes,  bedding,  or 
books  which  have  been  in  the  sick  room. 

It  is  most  important  to  know  that  patients  are  contagious, 
even  before  the  rash  comes  out,  and  that  the  poison  is  given 
off  into  the  air  even  from  the  bodies  of  those  who  have  died 
of  the  disease.  People  of  both  sexes  and  at  all  ages  are 
liable  to  it;  even  the  unborn  child  within  the  womb  may 
suffer  from  smallpox,  and  be  born  marked  with  the  results. 
At  the  present  time  smallpox  is  not  common,  and  the  num- 
ber and  severity  of  the  epidemics  have  been  reduced  by 
improved  sanitary  measures,  by  greater  cleanliness,  and, 
above  all,  by  efficient  vaccination.  Generally,  the  disease 
occurs  only  once  in  the  same  person. 

The  disease  begins  suddenly,  twelve  days  after  catching 
it,  with  a  severe  pain  at  the  bottom  of  the  back,  shivering, 
and  fever;  headache  and  vomiting.  On  the  third  day  the 
rash  comes  out.  (See  "Rashes  on  the  Skin,"  number  3.) 
There  are  several  varieties  of  smallpox,  named  according  to 
the  type  which  the  rash  assumes.  When  it  occurs  in  those 
who  have  been  vaccinated  years  before,  it  is  very  mild, 
and  is  called  varioloid. 

Treatment. — Nowadays,  when  a  case  of  smallpox  occurs, 
the  patient  is  generally  taken  off  to  the  nearest  fever  hos- 
pital, where  the  treatment  is,  as  a  rule,  excellent,  and  where 
the  patient  will  probably  recover.  Smallpox  is  apt  to  leave 
behind  some  very  disagreeable  complications — abscesses, 
conjunctival  inflammation  (see  "Eye  Diseases"),  middle- 
ear  disease  (see  "Ear  Diseases"),  bronchitis  or  paralysis. 
Cases  of  varioloid  generally  make  a  good  recovery.  Cases 
in  which  the  spots  (or  pocks)  run  together,  are  more  seri- 
ous. These  are  called  confluent  smallpox.  The  general 
principles  of  treatment  are  the  same  as  for  measles  (see 
"Measles"),  namely,  isolation,  disinfection,  and  rest. 
There  is  no  method  known  which  will,  in  every  case,  pre- 
vent the  scarring  and  pitting  of  the  skin.  (See  also  "Vac- 
cination.") 


SORE  THROAT  263 

Sore  Throat. — There  are  very  many  forms  of  disease 
which  may  affect  the  throat,  and  so  we  very  often  hear 
persons  say  that  the  throat  is  sore  or  relaxed.  Sore  throats 
may  be  considered  in  three  groups.  The  first  and  most 
common  forms  are  those  ailments  due  to  catching  cold  from 
exposure  to  cold  and  wet.  The  second  group  are  those 
cases  of  sore  throat  which  accompany  acute  fevers,  such  as 
scarlet  fever  and  diphtheria;  these  are  terribly  infectious, 
and  are  of  a  more  serious  nature.  And  the  third  sort  are 
truly  ulcerated  conditions  of  the  throat,  due  to  the  ravages 
of  venereal  disease.  Cases  of  this  last  variety  come  in  the 
secondary  stage  after  infection.  (See  "Syphilis.")  The 
soreness  may  last  for  months.  The  second  group,  those  of 
the  infectious  fevers  and  sewer-gas  poisoning,  are  acutely 
painful,  and  are  accompanied  by  high  fever.  In  scarlet 
fever,  unless  very  severe,  the  throat  gets  well  in  a  week. 
In  diphtheria,  which  mostly  affects  the  throat,  nostrils  and 
windpipe,  soreness  is  less  painful,  but  even  more  danger- 
ous, because  there  is  a  growth  of  false  membranes  in  these 
parts  which  may  cause  suffocation.  There  remains  the 
class  of  sore  throats  which  arise  from  chills ;  there  is  hardly 
any  more  common  accompaniment  of  a  cold,  or  catarrh, 
as  doctors  call  it,  and  some  persons  have  several  attacks 
each  year;  but  they  rarely  last  more  than  a  week  or  ten 
days.  Three  varieties  may  be  mentioned — first,  a  simple 
relaxed  throat,  in  which  the  mucous  membrane  is  seen  to 
be  red  and  somewhat  swollen,  wuh  a  long,  puffy  uvula  (the 
little  ball  which  hangs  in  the  center  of  the  throat),  and  an 
increased  amount  of  secretion.  The  next  form  is  more 
violent ;  there  is  a  bright  redness  of  the  parts,  with  swelling 
of  the  tonsils,  pain  and  difficulty  in  swallowing,  accom- 
panied by  thirst,  heat  of  skin,  and  general  f everishness ; 
this  sort  of  attack  may  pass  off  in  three  or  four  days.  The 
most  severe  form  of  sore  throat  is  seen  when  the  attack 
beginning  as  last  described  ends  in  a  definite  inflammation 
of  one  or  both  tonsils,  passing  on  in  the  course  of  a  week 
into  quinsy  (see  "Quinsy")  ;  and  in  such  cases  an  abscess 
forms  on  one  or  both  sides  of  the  throat,  and  then  there  is 
no  comfort  until  the  abscess  bursts  or  is  opened  by  the 
knife  of  the  surgeon. 

Treatment. — In  simple  relaxed  throat,  where  there  is  no 
fever  or  inflammation,  astringents  are  needed  locally,  either 
as  lozenges,  or  pastils,  or  jujubes,  medicated  with  tannin, 


264  SPECIALISTS 

rhatany,  or  catechu.  Formamint  lozenges  are  an  excellent 
remedy,  because  they  disinfect  the  throat.  Or  gargles  may 
be  used,  containing  alum,  or  sulphate  of  zinc.  The  chem- 
ist will  adjust  the  strength  according  to  the  age  of  the 
patient.  Some  prefer  to  have  the  parts  painted  by  a  soft 
brush  dipped  in  glycerin  of  tannin,  or  a  weak  solution  of 
the  chloride  of  zinc.  All  these  remedies  must  be  got  prop- 
erly made  by  a  chemist  of  suitable  strengths.  Quinine  and 
iron  tonic  medicines  will  also  be  required  to  tone  up  the 
system. 

Tonsilitis. — In  acute  inflammatory  sore  throat  the  pa- 
tient would  do  well  to  knock  off  work  as  soon  as  the  symp- 
toms are  developed,  and  to  take  to  bed  until  the  fever  and 
inflammation  have  passed  away.  Let  him  go  to  bed  after 
a  hot  bath — if  there  be  a  convenient  bath  indoors — and 
take  a  good  strong  dose  of  saline  purgative,  with  something 
warm  added  to  check  pain ;  such  a  dose  as  compound  senna 
mixture,  or  Epsom  salts  with  essence  of  ginger.  Put  on 
ample  bedclothes,  and  try  to  produce  a  profuse  perspira- 
tion. Steaming  the  throat  will  give  much  relief,  and  put 
on  a  warm  poultice  round  the  neck ;  it  may  be  made  of  hot 
water  with  bread,  or  linseed  meal,  or  boiled  turnip.  Dur- 
ing the  next  two  or  three  days  the  patient  must  take  only 
liquid  nourishment — gruel  and  broth — no  alcohol,  and  must 
not  smoke.  When  the  acute  illness  has  passed  off  the  case 
will  need  treating  as  for  relaxed  throat  as  already  de- 
scribed. In  the  more  severe  cases,  when  there  is  quinsy 
(abscess),  poultices  on  the  neck  will  be  much  needed,  and, 
in  addition  to  simple  steaming  of  the  throat,  inhalations 
medicated  with  compound  tincture  of  benzoin  (teaspoonful 
to  half-a-pint  of  hot  water,  repeated),  and  other  drugs  will 
hasten  the  cure.  Additional  internal  medicines,  such  as 
aconite,  antimony,  or  antipyrin,  are  commonly  adminis- 
tered every  two  or  three  hours,  to  combat  the  intensity  of 
the  inflammation.  These  require  a  doctor's  prescription. 
Cases  of  quinsy  require  careful  treatment  by  tonics  and 
local  astringents  for  several  weeks  after  the  disease  in  the 
tonsils  has  subsided. 

Specialists. — A  specialist,  in  the  medical  sense,  is  a  medi- 
cal man  who,  having  gone  through  the  course  of  study 
necessary  for  the  training  of  every  registered  doctor,  has 
given  up  " general  practice"  in  order  to  study  and  treat 
special  diseases  or  the  diseases  peculiar  to  one  special  or- 


SPECTACLES  AND  FAILING  SIGHT     265 

gan.  There  is  no  specialist  who  makes  a  profession  of 
dealing  with  only  one  disease — such  a  man  would  not  be 
worth  his  salt.  He  is  not  necessarily  better  educated  or 
more  highly  trained  than  the  family  doctor,  and  in  very 
many  instances  he  is  not  as  skillful  as  the  family  doctor, 
because  he  (the  specialist)  in  studying  his  own  specialty 
is  very  apt  to  become  narrow  in  his  judgment,  and  to 
tinker  unnecessarily  at  the  diseases  or  organs  which  he 
knows  most  about.  There  are  several  recognized  "special- 
isms" in  medicine  and  surgery.  Such  are  diseases  of 
women,  diseases  of  the  nose,  ear  and  throat;  diseases  of 
the  skin;  diseases  of  the  eyes;  venereal  diseases.  It  is 
quite  certain  that  as  time  goes  on  specialists  will  become 
more  and  more  numerous;  but  persons  who  can  afford  it 
are  too  ready  to  run  away  to  a  specialist  with  diseases 
which  the  family  doctor  is  perfectly  competent  to  treat. 
Pew  people  are  superior  to  the  curious  vanity  of  supposing 
that  their  illness  is  unusual,  rare,  difficult  to  treat,  and 
requiring  the  special  services  of  a  specially-skilled  person! 
There  are  no  such  doctors  as  "specialists  in  rupture,"  vari- 
cocele,  asthma,  bone  diseases  and  so  on. 

Spectacles  and  Failing  Sight. — We  refer  in  this  article 
to  the  failing  sight  of  those  persons  of  full  age  or  advancing 
old  age,  who  have  enjoyed  good  sight  all  their  lives.  Much 
of  this,  however,  will  also  be  applicable  to  those  who  are 
habitually  short-sighted  or  too  long-sighted.  These  two 
faults  depend  upon  a  naturally  badly-shaped  eyeball,  and 
the  vision  is  apt  to  fail  earlier  in  life  than  it  does  in  people 
with  well-formed  eyes.  The  most  common  reasons  for  fail- 
ing sight  in  adults  are  cataract,  glaucoma,  and  amaurosis, 
to  which  may  be  added  opacities,  clouds  on  the  cornea — 
that  is,  the  window  front  of  the  eye.  These  last  arise  from 
injuries,  or  from  ophthalmia,  which  means  inflammation 
of  the  eye  surface,  generally  arising  from  injuries  due  to 
irritating  dust  or  other  substances.  (See  also  "Eye  Dis- 
eases.") 

By  cataract  is  meant  slowly-growing  opacity,  or  want  of 
transparency,  affecting  the  lens  within  the  eyeball.  The 
effect  of  this  is  to  hinder  the  rays  of  light  from  passing 
into  and  across  the  interior  of  the  eyeball.  A  similar  effect 
is  seen  when  a  clear  plate  of  glass  is  breathed  upon,  or  is 
dusted  over  with  some  fine  powder;  one  can  no  longer  see 
clearly  through  it.  Cataract  is  due  to  a  slow  deterioration 


266  SPINAL  CURVATURE 

of  the  structure  of  the  lens — a  process  of  decay.  No  defi- 
nite cause  is  known;  all  our  organs  may  wear  out,  each  in 
its  own  peculiar  way.  Either  one  or  both  eyes  may  be 
affected  at  once,  or  one  may  first  suffer  and  then  the  other. 
No  curative  medical  treatment  is  known  of,  and  the  usual 
practice  is  to  await  the  stage  of  blindness,  and  then  to 
remove  the  offending  lens  by  a  surgical  operation;  if  this 
succeeds  the  patient  will  be  able  to  see  very  well  again, 
with  proper  glasses. 

Glaucoma  is  the  second  serious  cause  of  blindness,  and 
is  often  a  painful  disease,  which  cataract  is  not.  This  is 
a  state  due  to  obscure  inflammation  within  the  eyeball,  by 
which  it  becomes  tense  and  hard  from  undue  internal  pres- 
sure. It  is  more  common  in  a  chronic  form,  but  it  may 
suddenly  appear,  with  violent  pain,  as  an  acute  disease, 
which  may  very  soon  result  in  blindness.  In  some  cases, 
a  greenish  color  is  seen  when  looking  into  the  eyeball,  and 
another  symptom  is  the  sudden  onset  of  a  state  of  long- 
sightedness. 

Amaurosis,  the  third  form  of  disease  is  a  slowly  pro- 
gressing failure  of  sight,  due  to  disease  to  the  nerve  struc- 
tures of  the  internal  parts  of  the  eye ;  it  is  a  sort  of  palsy 
of  the  nerves  of  sight,  and  may  result  from  diseases  of  the 
brain,  and  may  follow  apoplexy. 

Our  sight  is  one  of  the  most  valuable  gifts,  and  any  dis- 
order of  vision  should  send  a  sufferer  in  all  haste  to  an 
ophthalmic  surgeon,  who  makes  diseases  of  the  eye  a  special 
study. 

Spinal  Curvature — Deformed  Back. — There  are  several 
varieties  of  deformity  affecting  the  spinal  column,  and 
these  may  be  curable  or  incurable.  They  may  be  due  to 
.general  debility  and  muscular  weakness,  or  to  bone  disease. 

The  spine  should  be  straight  up  and  down  when  seen 
from  behind;  but  when  seen  from  the  side,  it  has  special 
curves  in  health.  The  natural  curves  may  be  lost,  and 
improper  curves  appear  in  delicate  persons,  from  bad  habits 
of  sitting,  lounging,  or  working.  Children  at  school  often 
sit  very  badly  at  their  desks,  and,  of  course,  many  trades 
cause  deformity  from  the  continued  necessity  for  occupy- 
ing a  constrained  position,  as  in  cobblers  and  tailors. 

Near-sighted  persons  often  have  a  bent  neck  and  stooping 
gait  from  the  need  to  lower  their  eyes  to  their  work. 
Nurses  may  get  a  bent  spine  from  long  carrying  of  heavy 


SPINAL  CURVATURE  267 

babies.  Blacksmiths,  who  use  the  right  arm  so  much  more 
than  the  left,  often  get  the  spine  somewhat  curved.  At- 
tacks of  pleurisy,  by  injuring  one  lung,  often  deform  the 
chest  and  back.  Hip-joint  disease  and  other  ailments  of 
the  leg  and  foot,  by  causing  shortening  of  one  leg,  are 
often  followed  by  a  spinal  curvature. 

All  these  deformed  conditions  are  of  gradual  onset,  and 
of  slow  progress ;  but  once  developed  they  are  very  difficult 
to  cure. 

Persons  who  are  most  likely  to  suffer  are  those  who  are 
born  with  a  scrofulous  constitution.  (See  "Scrofula"  and 
"Chest,  Shape  of.")  They  are  generally  thin,  pale,  sal- 
low people,  flabby  of  skin  and  muscles,  and  they  have  a 
tendency  to  enlarged  glands  in  the  neck,  large  tonsils, 
large  bodies  and  thick  lips. 

Lateral  curvatures  are  mostly  from  debility,  and  are 
seen  in  girls  and  young  women  who  have  outgrown  their 
strength.  One  shoulder  becomes  higher  than  the  other, 
and  the  shoulder  blades  bulge  out  behind ;  one  hip  projects 
too  much,  and  the  other  looks  too  small.  The  spine  about 
the  middle  of  the  ribs  projects  too  much  either  right  or 
left.  This  deformity  injures  the  lungs  more  or  less  and 
displaces  the  heart,  and  so  there  may  be  pains  in  the  chest 
or  back,  or  in  the  sides,  and  the  breathing  may  be  oppressed 
and  the  digestion  disordered.  The  opposite  sort  of  curva- 
ture from  before  back  may  arise  from  an  injury  or  from 
disease  of  the  bones  called  vertebrae,  which  compose  the 
spine.  In  this  form  tuberculous  or  consumptive  disease 
may  cause  decay  of  one  of  the  bones,  so  that  instead  of 
its  being  firm  and  hard  it  will  soften  down  into  pus  and 
matter,  and  so  form  an  abscess ;  the  body  weight  then  bends 
the  spine  at  the  spot  thus  destroyed  by  disease.  The  result 
is  an  angular  curvature,  leading  to  hump-back.  This  dis- 
ease is  often  fatal,  although  many  cases  recover  health  to 
some  extent,  and  even  become  robust,  though  always  de- 
formed. 

In  childhood  bent  backs  can  be  treated  with  some  hope 
of  success  by  means  of  mechanical  appliances,  but  those 
occurring  in  later  life  can  rarely  be  treated  successfully. 
The  great  object  is  to  improve  the  general  health  over  a 
period  of  years  by  means  of  good  feeding,  suitable  exer- 
cises, frequent  changes  of  air,  and  by  giving  cod-liver  oil, 
maltine,  and  syrups  of  lime  and  iron. 


268  SQUINTING 

Sprains. — When  a  joint  is  sprained,  there  is  at  first  a 
little  pain  and  much  weakness.  Then  the  patient  lies  down 
and  the  pain  grows  worse,  and,  either  at  once,  or  very  soon, 
the  joint  begins  to  swell.  The  structures  in  the  interior 
of  the  joints  have  been  violently  treated  and  they  soon 
begin  to  bleed  under  the  skin.  That  is  called  at  home 
' '  black-and-blue "  and  is  the  result  of  a  bruise.  The  very 
first  thing  to  do  with  a  freshly-sprained  joint  is  to  hold  it 
under  a  stream  of  cold  water  from  a  tap  for  about  ten 
minutes.  Then  let  the  patient  lie  down  and  rest,  and,  if 
the  doctor  has  not  yet  arrived,  put  the  sprained  joint  in  a 
thoroughly  comfortable  position,  and  wrap  it  in  plenty  of 
cotton  wool,  and  bandage  it  firmly  and  rather  tightly.  If 
there  is  enough  cotton  wool,  it  will  equalize  the  pressure 
after  a  few  minutes.  It  is  not  a  good  plan  to  poultice  the 
limb,  even  to  relieve  the  pain,  because  the  swelling  is  in- 
creased in  that  way. 

The  greater  part  of  the  pain  and  loss  of  function  after 
a  sprain  results  from  the  swelling,  which  is  caused  by  the 
escape  of  blood  and  serum  into  the  tissues.  Recently  two 
methods  have  been  employed  to  prevent  this,  either  to 
"strap"  the  part  with  adhesive  plaster,  or  to  employ  mas- 
sage from  the  beginning.  The  latter  is  becoming  the  more 
popular  for  small  sprains. 

In  sprains  of  gouty  and  rheumatic  and  consumptive  peo- 
ple, constitutional  medical  treatment  by  a  doctor  must  be 
undertaken,  or  there  is  a  serious  risk  that  the  joint  may 
become  damaged  for  life. 

Sometimes  after  a  sprain  there  remains  a  good  deal  of 
chronic  thickening  of  the  skin  and  structures  of  the  joint. 
In  such  cases  people  sometimes  neglect  them  until  it  is 
too  late.  Massage  and  the  application  of  hot  and  cold 
water  douches  alternately,  are  useful  measures. 

Squinting. — This  well-known  deformity  generally  begins 
in  very  early  childhood,  but  in  a  few  cases  children  are 
actually  born,  if  not  with  a  squint,  at  all  events  with  the 
paralysis  of  one  of  the  eye  muscles  which  cause  a  squint 
as  soon  as  the  eyes  begin  to  see  things.  Squinting  is 
caused,  then,  by  paralysis  or  weakness  of  one  of  the  mus- 
cles which  turn  the  eyeball  from  side  to  side,  or  up  and 
down.  The  patient  tries  to  look  at  the  same  point  with 
both  eyes,  but  one  eye  cannot  be  brought  to  bear  on  the 
right  spot,  and  the  patient  then  is  said  to  squint.  If  one 


STAMMERING  269 

eye,  looking  straight  ahead,  sees  an  object,  and  the  other 
eye  looks  in  another  direction,  away  from  the  sound  eye, 
then  the  second  eye  is  partly  paralyzed,  and  squints.  This 
is  called  divergent  squint,  because  the  lines  of  sight  diverge 
from  one  another.  If,  on  the  other  hand,  one  eye  looks 
straight  at  an  object,  and  the  other  eye  looks  across  the 
path  of  vision,  then  the  squint  is  called  a  convergent 
squint,  because  the  lines  of  vision  converge  and  cross  each 
other.  Such  a  person  is  called  cross-eyed.  Sometimes  the 
squint  is  permanent;  sometimes  it  happens  only  when  the 
eyes  are  tired;  sometimes  only  one  eye  is  paralyzed,  and  in 
other  cases  both  eyes  squint.  When  the  sight  of  both  eyes 
is  good,  and  when  the  squinting  is  not  caused  by  paralysis, 
it  is  generally  curable  by  operation.  The  causes  of  squint 
are  many  and  various.  A  baby  may  squint  as  the  result 
of  irritation  caused  by  worms  in  the  bowels,  or  by  irritation 
of  the  nerves  caused  by  teething;  and  the  disease  known 
as  "water  on  the  brain,"  of  which  the  proper  name  is 
hydrocephalus.  In  the  great  majority  of  cases,  however, 
the  optic  nerves  and  eyeballs  themselves  are  badly  devel- 
oped second-rate  organs,  generally  smaller  than  they  should 
be,  and  badly  shaped.  The  operation  that  is  done  is  to  cut 
through  the  muscle  which  pulls  the  eyeball  out  of  position, 
and  the  muscle  is  left  to  attach  itself  to  a  more  suitable 
part  of  the  eyeball.  It  may  be  necessary  to  operate  twice, 
or  even  thrice.  The  operation  is  often  successful,  but 
sometimes  is  not.  It  can  do  no  harm,  if  skillfully  done, 
even  if  it  does  no  good.  Squint  caused  by  paralysis  can- 
not be  cured  in  the  majority  of  cases. 

Stammering. — We  are  frequently  asked  what  to  do  with 
a  child  who  stammers.  There  are  a  few  well-known  meth- 
ods of  dealing  with  stammering,  and  some  specialists  claim 
to  be  able  always  to  cure  the  complaint.  Boys  at  an  ordi- 
nary school  who  stammer  are  very  heavily  handicapped, 
and  their  lives  made  almost  unbearable  by  the  thoughtless 
teasing  and  wanton  mischief  of  the  other  boys.  In  itself, 
stammering  is  not  caused  by  general  debility;  but  stam- 
mering often  causes  general  debility,  spoiled  tempers,  and 
ruined  dispositions.  Boys  who  stammer  are  generally 
backward  in  their  education,  because  they  cannot  say  their 
lessons,  even  if  they  know  them;  and  if  they  are  lazy, 
they  shirk  their  work  because  they  think  their  stammering 
will  cause  it  to  be  passed  over.  Masters  cannot  be  blamed 


270  STOMACH  DISEASES 

for  passing  them  over,  either,  as  their  time,  and  the  time 
of  the  whole  class,  cannot  be  wasted  in  waiting  for  a  stam- 
mering boy.  Some  masters,  out  of  kindness,  try  and  help 
the  boys;  but  the  advice  is  often  misguided,  and  makes 
things  worse.  All  this  leads  to  the  conclusion  that  a  boy 
who  stammers  ought  to  be  taught  only  at  a  special  school 
for  stammerers.  The  question  of  what  to  do  with  a  boy 
or  girl  who  stammers  is  really  a  serious  one,  as  we  have 
seen,  if  the  stammerer  is  to  earn  a  living  in  these  days  of 
keen  competition.  There  is  no  doubt  that  stammering  is 
a  spasmodic  nervous  disorder,  and  the  first  need  is  for 
medical  treatment,  directed  towards  quieting  down  a  too 
sensitive  nervous  system.  It  will  be  noticed  that  nobody 
stammers  when  he  sings;  and  so  the  best  way  for  a  stam- 
merer to  begin  to  cure  himself  is  to  say  everything  in  a 
sing-song  way,  and  only  very  gradually  to  come  to  one 
note,  and  then  to  ordinary  speech.  The  stammerer  finds 
his  greatest  difficulty  in  the  use  of  consonants  as  "f"  and 
"v"  which  entirely  supersede  the  passage  of  air  through 
the  nose,  and  where  the  necessity  arises  for  firm  contrac- 
tion of  parts  of  the  mouth.  But  the  real  cure  of  stammer- 
ing must  be  left  to  the  specialists,  only  one  or  two  of  whom 
are  medical  men. 

Stomach  Diseases. — It  is  often  a  difficult  matter  to  dis- 
cover whether  the  stomach  is  diseased  or  not,  because  symp- 
toms arising  from  upset  stomach  and  disordered  digestion 
accompany  almost  all  fevers  and  many  other  diseases  as 
well.  True  stomach  pain  is  not  very  common,  but  stomach- 
ache is  the  most  usual  name  for  all  pains  in  the  body  lower 
than  the  fifth  ribs,  so  that  the  name  has  lost  all  accurate 
meaning.  Stomach-ache,  in  most  cases,  means  a  pain  in 
the  intestines  or  bowels,  due  to  either  colic  or  the  irritation 
accompanying  diarrhea.  Most  people  speak  of  "stomach" 
when  they  mean  "belly"  or  "abdomen."  Now,  the  stom- 
ach itself  is  a  hollow  bag,  with  thin  coats;  its  sides  fall 
together  when  empty;  but  when  food  and  drink  are  taken 
it  will  dilate  so  as  to  hold  one  or  two  quarts ;  then  it  gradu- 
ally shrinks  as  it  empties  itself  during  digestion,  into  the 
bowels.  Diseases  of  the  stomach  itself  are  of  two  kinds — 
organic,  in  which  the  coats  of  the  stomach  are  diseased  by 
inflammation,  ulceration,  or  cancer;  and  functional,  in 
which  the  action  of  the  stomach  as  a  digestive  organ  is 


DILATED  STOMACH  271 

alone  impaired.  The  healthy  stomach  when  it  receives 
food,  pours  out  a  liquid  called  gastric  juice,  which  digests 
the  food,  especially  meat  foods.  During  digestion  the 
stomach  is  in  constant  motion,  though  we  are  quite  un- 
conscious of  it,  churning  up  the  chewed  food  and  gastric 
juice  together.  This  process  should  be  painless.  It  will  be 
obvious,  when  thought  about,  that  if  the  internal  coats  of 
the  stomach  are  tender,  sore,  or  inflamed,  the  movements 
of  the  stomach  will  be  painful ;  and  if  the  patient  be  in  bad 
health,  the  gastric  juice  will  not  be  in  a  good  condition, 
and  so  the  food  is  delayed  in  the  stomach,  imperfectly 
digested.  The  results  are  that  the  food  ferments,  turns 
sour,  and  causes  nausea  and  sickness.  Diarrhea  often  fol- 
lows this  state  of  indigestion,  which  doctors  often  call  dys- 
pepsia. The  liver  often  " sympathizes"  with  an  upset 
stomach,  and  then  the  bile  also  becomes  unhealthy,  and 
unable  to  perform  its  special  duty  of  digesting  fats  in  the 
intestines. 

Gastritis. — Gastritis  is  the  name  for  inflamed  stomach. 
Acute  gastritis  is  not  usual;  it  is  due  to  poisons,  caustics, 
swallowing  hot  liquids,  and  violent  spirit-drinking  bouts. 
Chronic  gastritis  is  often  associated  with  liver  disease,  im- 
proper diet,  free  drinking,  and  especially  with  consumption 
of  the  lungs.  It  is  shown  by  nausea  and  sickness,  pain 
under  the  left  ribs  in  front  and  side,  some  tenderness  there, 
water  brash,  heartburn,  and  disordered  action  of  the 
bowels. 

Bilious  Attacks. — Gastric  catarrh  may  come  on  as  part 
of  a  general  cold  or  catarrh,  or  it  may  come  on  periodically, 
especially  in  feeble  persons,  who  generally  call  this  ailment 
by  the  common  title  of  bilious  attack. 

Dilated  Stomach. — In  some  unfortunate  persons  the 
stomach  dilates  with  each  meal,  but  fails  to  shrink  back  to 
its  naturally  small,  empty  state;  and  after  some  months 
of  dilating,  a  state  of  chronic  indigestion  arises,  because 
the  stomach  is  never  quite  emptied  between  meals,  as  it 
should  be.  In  this  condition  there  are  nausea  and  occa- 
sional sickness,  with  loss  of  appetite  and  cramp-like  pains 
in  the  stomach;  constipation  is  common,  with  much  flatu- 
lence. Vomited  matters  will  be  found  dark,  undigested, 
and  sour-smelling  from  having  been  delayed  so  long  as  to 
have  fermented. 


272  STONE  IN  THE  BLADDER 

Cancer  of  the  stomach. — Cancer  of  the  stomach  is  most 
often  seen  in  men  past  middle  age ;  it  is  a  very  painful  dis- 
ease, and  proceeds  to  a  fatal  issue. 

Ulcer  of  Stomach. — Ulcer  of  the  coats  of  the  stomach  is 
an  ailment  very  common  in  young  women,  and  this  also 
may  be  fatal,  from  accidental  rupture  of  diseased  blood 
vessels.  If  a  young  woman  complaining  of  want  of  appe- 
tite, pain  after  eating,  and  general  indigestion,  is  found 
to  become  daily  more  pale  and  weak,  the  presence  of  an 
ulcer  in  the  stomach  must  be  suspected.  The  ulcer  is  round 
or  oval,  and  on  the  inner  aspect  of  the  stomach  coats,  but 
may  be  on  the  front  or  the  back  of  the  organ;  according 
to  its  position,  the  place  where  the  pain  is  felt  will  vary. 
The  pain  is  worst  after  food  for  an  hour  or  more;  sour 
liquids  rise  up  in  the  throat,  and  slight  vomitings  are  com- 
mon. There  is  most  danger  when  such  an  ulcer  eats  so 
deeply  into  the  coats  of  the  stomach  as  to  cause  bleedings. 
There  may  be  only  smears  of  blood  on  what  is  brought  up 
by  vomiting,  or  there  may  be  a  tablespoonful  or  more  of 
blood,  generally  dark  and  clotted,  and  not  frothy,  as  it  is 
when  coughed  up  from  the  lungs.  Of  course,  if  an  ulcer 
eats  into  a  large  vein,  the  bleeding  will  be  profuse,  so  great 
even  as  to  cause  fainting;  but  the  hemorrhage  may  be  all 
internal  and  give  no  sign  of  its  occurrence. 

Perforated  Ulcer. — An  even  more  dangerous  accident  is 
when  the  ulcer  eats  quite  through  the  thin  stomach  walls, 
and  then  the  blood,  liquid  food,  and  gastric  juice  escape 
into  the  general  space  within  the  body.  Such  an  event 
causes  instant  collapse,  intense  pain,  and  very  often  a  sud- 
den death.  In  that  case  the  only  chance  of  recovery  is  an 
immediate  surgical  operation  to  sew  up  the  perforation. 
From  these  facts  it  will  be  obvious  that  cases  of  severe 
indigestion  should  be  watched  by  a  doctor.  In  mild  cases 
of  dyspepsia,  domestic  treatment  should  endeavor  to  regu- 
late the  bowels  to  one  or  two  daily  actions  by  means 
of  rhubarb,  senna,  or  cascara.  A  dose  of  rhubarb,  soda, 
and  ginger  will  often  relieve  stomach  discomfort.  Indiges- 
tion should  not  be  treated  by  giving  spirits,  because  it  is 
easy  to  begin  a  habit  of  having  recourse  to  strong  drinks 
to  cure  small  ailments.  (See  "Indigestion.") 

Stone  in  the  Bladder.—  (See  "Bladder  Diseases.")  The 
signs  of  a  stone  in  the  bladder  are — pain  in  the  region  of 
tjie,  bladder,  and  in  the  bottom  of  the  back,  too  frequent. 


STRONG,  HOW  TO  BECOME  273 

desire  to  pass  water;  the  water  passed  often  containing 
blood  (and  looking  "smoky") ;  the  passage  sometimes  of 
pure  blood;  shivering  fits.  The  pain  is  generally  most 
violent  immediately  after  passing  the  last  few  drops  of 
water. 

Strong,  How  to  Become. — (A  warning!) — This  is  too  wide 
a  subject  to  deal  with  in  much  detail  within  the  limits  of 
the  short  articles  in  this  book. 

Everyone  nowadays  realizes  that  to  become  physically 
strong  it  is  necessary  to  live  steadily,  purely,  cleanly,  and 
to  take  sufficient  and  suitable  exercise.  The  leisured  man 
gets  his  cricket,  his  football,  his  tennis,  his  golf,  and  his 
hockey.  The  man  of  small  means  and  small  leisure  time 
must  needs  take  his  exercise  in  walking  or  in  gymnastics. 
The  home-gymnastics  method  is  now  very  largely  catered 
for.  There  is  an  ever-increasing  crowd  of  "professors" 
and  "strong  men"  and  "culture  teachers"  of  more  or  less 
ability.  They  nearly  all  have  one  serious  fault.  They 
advertise  that  they  can  make  anybody  and  everybody 
"strong."  They  show  photos  and  pictures  of  men  of 
enormous  and  unnatural  muscular  development,  and  they 
try  to  make  you  believe,  first,  that  it  is  desirable  to  have 
such  an  excessive  development,  and  secondly,  that,  whoever 
you  are,  you  can  be  made  equally  big  and  strong  by  their 
particular  method.  Now,  it  is  an  undoubted  fact  that 
thousands  of  people  are  lamentably  undeveloped  in  every 
way;  that  girls  grow  up  flat-chested  and  narrow-hipped 
all  over  the  country.  Hence  the  frequent  advertisements 
of  bust  developers,  which  aim  only  at  increasing  the  fat 
over  the  neck  and  breasts  and  at  enabling  a  woman  to 
present  a  good  appearance.  Young  men  are  to  be  seen  in 
plenty,  round-shouldered  and  flabby  in  muscle.  No  one 
will  wish  to  deny  that  all  these  young  people  could  be  im- 
proved by  systematic  development,  and,  if  only  the  gym- 
nastics employed  are  suitable  to  the  individuals,  all  will  go 
well.  With  gradual  muscle  development  comes  renewed 
health. 

But  the  "  let-me-make-you-strong "  professor  teaches  that 
anyone  can  attain  a  fine  physical  and  muscular  develop- 
ment. This  is  not  true.  Doctors  will  tell  you  that  very 
numerous  cases  of  damage  done  by  injudicious  muscular 
exercise  come  to  their  notice  every  year.  The  physical 
culture  cranks,  keep  very  quiet  about  the  overstrained, 


274  SUMMER  HOLIDAYS 

hearts,  and  the  muscular  debility  and  the  mental  im- 
poverishment produced  in  some  of  their  customers.  It  is 
so  easy  to  go  to  excess  in  the  ambition  to  become  a  Hercules 
— so  easy  to  overtax  a  heart  that  would  have  been  quite 
adequate  for  all  ordinary  purposes.  Not  everyone  has  a 
heart  and  vessels  which  will  bear  the  strain  of  daily  con- 
centrated muscular  exercise.  Only  the  very  few  can  ever 
attain  to  the  dimensions  of  a  Samson.  Once  a  person  has 
had  rheumatism,  for  instance,  his  heart  is  forever  unfit  to 
do  much  more  than  the  ordinary  routine  demands.  (See 
"Exercise  and  Recreation.") 

Struma.— (See  "Scrofula.") 

Stun, — (See  "Concussion  of  Brain.") 

Styes. — A  stye  is  inflammation,  and,  at  last,  abscess 
round  the  root  of  an  eyelash.  The  whole  eyelash  gets 
red  and  swollen,  and  just  as  one  stye  is  quieting  down  and 
getting  well  another  one  begins.  Styes  are  practically 
boils  of  the  eyelid. 

Treatment. — As  soon  as  you  see  a  stye,  look  at  the  eye- 
lid through  a  magnifying  glass,  and  with  a  fine  pair  of 
forceps  pull  out  the  eyelash  which  is  in  the  very  center 
of  the  reddest  part  of  the  inflammation.  A  tiny  drop  of 
matter  may  come  out  then,  and  when  it  has  been  wiped 
away  with  a  clean  bit  of  cotton  wool,  touch  the  place  with 
the  blunt  end  of  a  needle  which  has  been  dipped  in  pure 
carbolic  acid.  In  those  cases  where  styes  are  always  com- 
ing, owing  to  the  weak  state  of  health  of  the  patient,  it  is 
a  good  plan  to  apply  weak  yellow  oxide  of  mercury  oint- 
ment along  the  edge  of  the  eyelid  twice  a  day.  The 
patient  ought  to  ask  his  doctor  to  prescribe  a  tonic  for  him 
also. 

Summer  Holidays. — Now  is  the  time  to  sound  a  note  of 
warning  for  those  who  are  going  to  take  a  holiday — the 
one  holiday,  perhaps,  of  the  whole  year.  What  are  the 
benefits  that  we  expect  to  derive  from  this  yearly  cessa- 
tion from  work?  It  is,  firstly,  a  change  of  occupation  for 
the  mind,  and  change  of  occupation  means  rest,  and  rest 
means  recuperation  and  refreshment.  Secondly,  it  is  a 
change  of  habits,  diet,  and  air  for  the  body.  The  change 
brings  fresh  zest  to  life,  fresh  enjoyment  to  mere  eating, 
drinking,  and  sleeping;  and  if  a  holiday  is  properly  used, 
the  whole  system  is  invigorated.  But,  just  as  there  is  a 
right  way  and  a  wrong  way  in  everything  else,  in  holiday 


SYPHILIS  275 

making  it  is  possible  to  be  foolish  and  thoughtless,  and  to 
return  from  the  annual  outing  in  worse  condition  than 
before.  The  artisan's  wife  and  children  go  down  to  Ocean 
Grove  for  a  fortnight.  The  children  (unless  they  are  al- 
lowed to  paddle  beneath  a  broiling  sun  and  get  sunstroke, 
or  else  overeat  themselves  with  fruit  or  ices  and  get 
choleraic  diarrhea)  will  very  likely  benefit  greatly  by  the 
change  of  air,  by  the  exercise,  the  lack  of  restraint,  and 
the  country  food.  But  for  the  wife  and  mother  herself  the 
holiday  is  too  often  but  a  period  of  extra  anxiety  and  wor- 
ries. The  bother  of  getting  suitable  lodgings,  of  packing 
for  the  family,  of  procuring  and  preparing  victuals  in  un- 
familiar and  often  unsuitable  places,  and  the  worry  of 
keeping  an  eye  on  the  children,  to  see  that  they  don't  fall 
into  the  sea,  off  the  end  of  the  pier,  or  over  the  side  of 
the  Skylark,  or  get  lost  on  the  crowded  sands — all  these 
matters  deprive  the  poor  woman's  holiday  of  a  good  deal 
of  its  restfulness.  Poorer  and  less  fortunate  people  still 
(and  there  are  hosts  of  them  in  our  great  cities  and  else- 
where) get,  perhaps,  only  a  few  days,  or  a  week,  of  holi- 
days. It  is  no  real  holiday  to  scamper  off  to  Ocean  Grove 
by  the  steamer  for  one  day  only.  Thousands  do  it,  and, 
perhaps,  the  change  does  some  of  them  good.  But  the 
weakly  ones  only  get  tired  out,  and  we  have  seen  children 
and  adults  in  these  crowds,  at  the  end  of  the  day, 
thoroughly  exhausted  with  unwonted  excitement  and 
bustle.  Holidays  should  be  arranged  with  a  view  of  rest- 
fulness.  If  your  holiday  time  be  very  short,  don't  go  a 
long  way  from  home  to  a  crowded  place.  Go  into  a  quiet 
country  or  seaside  place ;  sit  about  in  the  open  air  and 
sunshine;  don't  "live"  every  minute  of  the  time  in  the 
silly,  nervous,  modern  way,  but  just  "exist,"  quietly 
enjoying  the  calm  beauty  of  the  landscape,  or  the  sea,  or 
whatever  scenery  there  may  be,  and  the  inspiriting  music 
of  the  bands.  Then,  when  you  return  to  the  busy  hum  of 
city  life,  with  its  unending  toil,  you  will  feel  that  the 
"holy  calm,"  and  perfect  quiet  and  rest,  have  done  you 
some  real  good.  (See  also  "Change  of  Air.") 

Sunstroke.—  (See  "Heatstroke.") 

Sweating. —  ( See  ' '  Perspiration. ' ' ) 

Syphilis  (The  "Bad  Disorder"). — This  is  the  most  impor- 
tant of  the  venereal  diseases.  Syphilis  spoils  the  lives  of 
thousands  every  year.  It  is  contagious,  not  only  through 


276  CONGENITAL  SYPHILIS 

sexual  congress,  but  even  through  kissing,  or  using  the 
pipe  or  cup  of  a  contagious  person.  The  disease  is  indeed 
a  dread  one,  and  those  who  suffer  from  it  may  infect  a 
great  many  during  the  two  or  more  years  that  the  con- 
tagiousness lasts.  The  man  who  contracts  it,  if  untreated 
or  improperly  treated,  may  suffer  from  it,  or  its  complica- 
tions, all  his  life;  and  symptoms  may  crop  up  as  many  as 
thirty  or  more  years  after  it  was  caught.  Thousands  of 
wives  suffer  chronic  ill  health  all  their  married  life  from 
having  caught  syphilis  from  their  husbands.  Hundreds  of 
doctors  suffer  from  blood-poisoning  caught  from  patients 
with  syphilis  which  they  have  been  treating  and  trying  to 
cure.  And,  worst  of  all,  the  sins  of  the  parents  are  visited 
on  the  children,  even  to  the  third  and  fourth  generation; 
for  syphilis  is  the  cause  of  a  large  proportion  of  all  mis- 
carriages, and  hundreds  of  innocent  children  are  born  every 
year,  alive,  but  with  ' '  hereditary  "  or  ' '  congenital ' '  syphilis 
in  their  bodies. 

There  are,  then,  two  kinds  of  Syphilis — the  Congenital 
and  the  Acquired. 

(1)  CONGENITAL  SYPHILIS. — Children  born  of  parents 
in  the  secondary  stage  will  almost  certainly  in  every  case 
be  the  victims  of  congenital  syphilis.  As  a  rule,  when  the 
parents  have  arrived  at  the  tertiary  stage  (see  next  section 
— " Acquired  Syphilis")  their  child  escapes  the  disease. 
One  attack  of  syphilis  protects  against  a  second;  no  one 
gets  syphilis  twice.  In  a  large  majority  of  cases  the 
syphilitic  child  is  born  apparently  quite  healthy  and  looks 
plump  and  well  for  about  three  or  four  weeks.  Then  it 
gets  "snuffles,"  a  bad  cold  in  the  nose  with  a  discharge 
of  pus  and  dirty  crusts.  Then  comes  a  RASH  on  the  skin, 
on  the  thighs,  back,  buttocks,  and  belly.  This  eruption  is 
the  color  of  raw  lean  ham,  but  it  must  not  be  confused  with 
another  skin  disease  called  intertrigo.  Only  a  doctor  can 
distinguish  them. 

Then  there  may  be  pimples,  blotches,  sores  all  over  the 
poor  little  body,  and  the  face  of  the  child  gets  wrinkled 
and  like  the  face  of  a  little  old  man  or  woman. 

It  must  be  borne  in  mind  by  parents  that  this  disease  is 
very  tractable  if  it  is  dealt  with  early  enough,  and  the 
careful  treatment  of  a  family  physician  will  do  much 
towards  converting  a  miserable,  puny,  diseased  baby  into 
a  crowing,  laughing,  healthy  little  person! 


ACQUIRED  SYPHILIS  277 

(2)  ACQUIRED  SYPHILIS. — We  shall  follow  a  case  of 
syphilis  through  all  its  stages. 

Firstly,  inoculation. — The  poison  is  transferred  by  sexual 
connection,  or  by  kissing  or  other  contact,  to  the  healthy 
skin,  and  enters  it  through  a  minute  crack  or  scratch, 
which  is  perhaps  too  small  to  be  noticed. 

Nothing  happens  for  a  period  of  from  two  to  three  weeks. 
Then  there  comes  at  the  infected  spot,  a  red  pimple,  like 
a  hard,  flat,  dry  button,  called  a  "hard  chancre."  This 
occurs  on  the  skin.  But  if  the  mucous  membrane  be  in- 
fected instead,  there  is  a  sore  instead  of  a  button  or  pimple, 
which,  only  after  about  ten  days,  seems  to  be  situated  on 
a  little  disk  of  parchment  slipped  under  the  skin.  This, 
then,  is  the  hard  chancre,  the  "primary  stage"  of  this 
disease. 

The  writer  imagines  that  no  one  with  any  such  sore 
would  be  foolish  enough  not  to  consult  a  doctor  at  once 
about  it.  And  it  may  be  said  at  once,  that  if  the  doctor 
decides  that  the  sore  is  a  "  hard  chancre, ' '  then  the  patient 
has  the  disease  called  syphilis;  he  will  be  contagious,  and 
must  at  once  start  treatment  for  eighteen  months  or  two 
years  under  medical  supervision. 

The  PRIMARY  STAGE  OP  SYPHILIS,  then,  consists  in  the 
presence  of  a  sore  at  the  place  of  inoculation.  The  nearest 
lymphatic  glands  (generally  in  the  groin)  become  hard 
and  lumpy  and  tender.  In  some  cases,  this  stage  is  the 
whole  of  the  disease,  and  the  victim  is  never  troubled  with 
it  again  if  he  carefully  carries  out  the  whole  two  years' 
treatment.  In  the  majority  of  cases,  however,  four  to  six 
weeks  after  the  hardening  of  the  chancre  the  second  stage 
begins. 

SECONDARY  STAGE. — Note  carefully  that  these  "stages" 
are  only  so  called  for  convenience'  sake.  Nature  does  not 
always  arrange  the  disease  exactly  as  here  described.  The 
chief  signs  of  secondary  syphilis  are  as  follow,  but  some  of 
them  may  be  absent,  and  others  may  be  present: — 

(1)  Eruptions  of  the  skin.     These  are  raw  ham  or 
coppery  colored ;  occur  on  both  sides  of  the  body ;  do  not 
itch;  do  not  leave  scars;  and  are  sometimes  of  every 
possible    variety — pimples,    blotches,     blebs,     abscesses, 
patches,  scales,  wheals,  nodules,  scabs,  etc. 

(2)  Moist  patches — very  contagious  indeed — about  the 
mouth,  nostrils,  and  back  passage. 


278  TERTIARY  SYPHILIS 

(3)  Sore  throat,  which  often  gets  ulcerated,  and  if  not 
treated  well  may  lead  to  scars  which  deform  the  throat 
and  spoil  the  voice  of  the  sufferer. 

(4)  Enlarged  glands  in  various  parts. 

(5)  The  hair  comes  out,  and  sometimes  the  nails  are 
shed  also. 

(6)  Sometimes  paralysis  occurs. 

Then  comes  a  period  of  rest.  The  disease  appears  to  be 
gone  for  ever — cured,  and  sometimes  there  is  no  more  of 
it.  But  in  some  people  there  comes  an  intermediate  stage, 
called  "Reminders"  stage. 

"REMINDERS"  of  Syphilis. — These  may  take  dozens  of 
forms.  Among  them  are  scaly  patches  on  the  hands  (called 
psoriasis  of  the  palms),  and  various  eye  troubles. 

TERTIARY  SYPHILIS. — At  last,  at  the  end  of  about 
eighteen  months  to  two  years  after  the  chancre,  the  third 
stage  of  the  disease  begins.  There  is  no  hard  and  fast  line 
between  the  secondary  and  tertiary  stages,  but  when  the 
secondary  symptoms  have  quite  disappeared,  and  two  years 
have  elapsed  since  the  chancre,  the  tertiary  stage  is  said 
to  have  begun.  As  said  above,  not  everyone  gets  any 
symptoms  in  the  third  stage;  but  once  the  last  secondary 
symptom  has  gone,  the  disease  is  no  longer  contagious,  and 
though  the  patient  may  have  to  suffer  himself,  at  any  rate 
he  (generally)  cannot  make  his  wife  suffer  or  give  the 
disease  to  his  children.  The  symptoms  of  the  tertiary  stage 
may  be : — 

(1)  Skin  eruptions,  scattered,  affecting  only  one  side 
of  the  face  or  body,  forming  sores  (ulcers),  and  leaving 
deep  scars. 

(2)  Lumps  in  any  part  of  the  body   (called  nodes), 
on  the  surface,  or  in  the  bones,  or  in  the  organs. 

(3)  Tumors  in  any  part  of  the  body,  such  as  the  liver 
or  brain ;  these  are  called  gummata. 

(4)  Destruction  of  the  testicles  in  men  and  ovaries  in 
women. 

(5)  Fits,  convulsions,  paralysis. 

Now,  the  reader  who  has  acquired  syphilis  and  who  has 
read  carefully  all  the  foregoing  is  by  this  time  probably 
much  alarmed  at  the  prospect  and  severity  of  the  disease. 
He  will  ask,  at  this  point,  three  questions : — 


SYPHILIS  279 

(1)  How  can  any  one  be  sure  that  he  has  contracted 
syphilis  ? 

(2)  How  long,  and  in  what  manner,  is  a  syphilitic 
person  dangerous  to  society? 

(3)  Can  the  disease  be  cured? 

The  answers  are  as  follow: — 

There  is  only  one  way  of  deciding  the  presence  or  absence 
of  syphilis,  and  that  is  to  consult  a  surgeon  of  repute,  and 
be  guided  in  this  very  serious  matter  wholly  by  his  ad- 
vice. No  one  can  keep  the  thing  secret  and  get  well.  The 
doctor  must  be  taken  into  your  confidence,  and,  cost  what 
it  may,  he  must  be  consulted  from  time  to  time  for  the 
next  two  years  at  least. 

The  answer  to  the  question  as  to  whether  syphilis  can 
be  quite  cured  turns  on  the  meaning  which  is  given  to  the 
word  cure.  Some  people  seem  to  get  " cured"  very  soon, 
and  are  little  the  worse  for  the  experience.  Yet,  if  even 
they  decide  to  neglect  the  treatment,  they  will  almost  cer- 
tainly suffer  in  later  life.  The  disease  becomes  quiescent, 
but  no  one  can  be  sure  that  it  will  not  break  out  again  later 
on.  Whereas  the  man  who  continues  treatment  for  about 
two  years  is  as  safe  as  medicine  can  make  him. 

The  drug  which,  by  universal  consent,  is  allowed  to 
have  most  influence  in  the  cure  of  syphilis  is  mercury.  If 
given  regularly — and  suitably — from  the  first  it  modifies 
and  at  last  demolishes  the  disease.  Mercury  must  be  taken; 
but  as  to  how  it  is  to  be  taken  we  can  only  say  that  this 
must  be  decided  by  the  doctor,  according  to  the  age,  sex, 
and  habits  of  the  patient,  and  the  severity  of  the  attack. 
It  is  worse  than  useless  to  expect  to  get  one  prescription 
which  will  suit  all  cases,  or  all  stages  of  the  same  case.  To 
neglect  medical  advice  in  this  matter  is  to  run  into  danger 
which  may  affect  one's  whole  life.  Syphilis  is  curable — 
in  many  cases,  entirely  so;  in  many  others,  the  patient 
must  be  content  if  he  gets  rid  of  all  symptoms,  and  must 
put  up  with,  as  inevitable,  the  weakness  which,  to  some 
extent,  always  remains. 

In  short,  though  signs  of  syphilis  may  be  got  rid  of, 
and  a  cure,  in  that  sense,  obtained,  yet  the  patient  is  never 
quite  the  same  person  again,  but  has  been  subjected  to 
a  poison  which  may  (or  may  not)  give  him  trouble  for  the 
rest  of  his  life.  His  best  chance  of  escaping  the  effects  of 


280  TATTOO  MARKS 

the  disease  is  to  live  a  quiet  life,  and  especially  to  avoid 
alcoholic  excess.  Alcohol  especially  renders  him  liable  to, 
and  aggravates,  all  the  symptoms  of  the  tertiary  stage. 

Recently  a  new  preparation  has  been  discovered,  known 
as  "606,"  for  the  treatment  of  syphilis.  This  has  been 
found  efficacious  in  a  large  number  of  cases,  especially  the 
old  resistant  ones;  but  the  technique  of  administration  is 
difficult  and  it  can  only  be  given  by  an  experienced 
physician. 

Taller,  How  to  Grow. — Let  it  be  noted  that  Nature  seems 
to  have  fixed  an  average  height  for  the  Anglo-Saxon — 
about  5  feet  8  inches — and  that  she  maintains  it  with  con- 
siderable persistency.  If  one's  father  and  mother  are 
above  the  average  height,  one  is  most  probably  an  inch  or 
so  shorter  than  one's  parents;  if  the  parents  are  under- 
sized the  child  is  generally  an  inch  or  so  taller.  If  the 
mother  is  too  short  the  sons  tend  to  be  too  tall,  and  if  the 
father  is  undersized  the  daughters  are  probably  taller  than 
the  average.  There  are  ways  of  increasing  the  height  of 
individuals,  nevertheless. 

Firstly,  we  nearly  all  stoop,  and  do  not  appear  as  tall 
as  we  really  are.  This  is  the  first  thing  to  attend  to,  then, 
to  stand  and  sit  upright,  even  at  the  office  desk.  The  back 
muscles  need  to  be  strengthened  to  bring  about  this  re- 
sult, and  that  can  be  done  by  using  one  of  the  "developers" 
on  the  market — all  are  equally  good  if  intelligently  used 
— or  with  dumb-bells.  Indian-club  exercise  is  an  excel- 
lent means  of  increasing  the  height.  After  thirty  it  is 
well-nigh  impossible  to  get  taller,  except  by  straighten- 
ing out  the  back ;  or  to  look  taller,  except  by  wearing  eleva- 
tors in  the  shoes  and  boots. 

Secondly,  there  is  a  method  used  by  the  American 
cavalrymen  and  others — stand  upright  with  back  to  a  wall 
until  quite  erect.  Then  take  two  paces  forward  away 
from  the  wall.  Eaise  the  arms  slowly  with  the  palms  for- 
ward, up,  up,  until  the  forefingers  meet  over  the  head. 
Keep  the  arms  unbent.  Do  this  slowly,  thirty  times  on 
first  rising  in  the  morning,  and  thirty  times,  when  un- 
dressed, before  going  to  bed  at  night.  Thus  can  you  add 
about  an  inch  to  your  stature,  if  you  are  not  yet  thirty 
years  of  age. 

Tattoo  Marks. — Let  us  urge  the  reader,  whoever  he  or 
she  may  be,  not  to  submit  to  the  wiles  of  the  tattooer, 


TEETH,  CARE  OF  281 

even  for  the  sake  of  having  the  flag  or  a  sweetheart's 
name  or  initials  tattooed  on  his  arm  or  chest.  In  later 
life  everyone  regrets  these  marks,  for  if  tattooing  is  prop- 
erly done,  the  marks  never  can  be  removed.  Glycerin  of 
papain  has  been  used  to  destroy  tattoo  marks,  but  in  any 
case  a  skin  surgeon  should  be  consulted  if  removal  is  de- 
sired. 

Teeth,  Care  of. — Our  teeth  give  us  trouble  from  the 
cradle  to  the  grave.  As  infants,  the  growing  and  cutting 
of  our  teeth  of  the  first  set  cause  pain,  feverishness,  and 
often  convulsions.  No  sooner  are  they  all  cut  but  they 
begin  to  get  loose  and  fall  out,  and  very  often  they  suffer 
from  decay  as  well.  In  some  states  of  constitution  these 
teeth  may  be  decayed  even  before  they  are  cut. 

Before  all  the  first  set  of  teeth  is  got  rid  of,  the  first 
double  teeth  of  the  second  set  appear  at  five  or  six  years 
of  age,  followed  by  the  front  teeth,  then  the  side  ones, 
and  lastly  the  double  ones  behind  the  first  great  grinders. 
This  process  may  be  finished  at  12  years  of  age.  The  four 
wisdom  still  remain,  and  they  may  not  be  fully  through 
the  gums  until  24  years  of  age,  and  sometimes  they  never 
appear  at  all. 

The  cutting  of  the  teeth  of  the  second  set  may  be  fairly 
painless,  but  the  cutting  of  the  final  four  wisdom  teeth 
may  give  rise  to  persistent  neuralgia. 

A  man  or  woman  is  blest  if  born  with  a  good  constitu- 
tion and  a  perfect  set  of  strong,  regularly  placed  teeth; 
they  escape  hours  of  face-ache,  and  much  indigestion, 
which  is  sure  to  result  from  improperly  masticated  food. 
There  are  some  few  people  fortunate  enough  to  preserve 
all  their  teeth  until  they  reach  the  age  of  three  score  and 
ten,  but  they  are  very  few;  in  olden  days  they  were  more 
numerous,  and  among  savages,  uncontaminated  by  our 
civilized  habits  of  feeding,  they  are  common  still. 

Very  few  of  us  have  no  decayed  teeth,  and  many  of  us 
lose  some  teeth  almost  every  year  from  the  time  we  get 
them.  This  is  no  new  ailment,  for  we  know  that  the  ancient 
Egyptians  suffered  to  some  extent  from  decay  of  the 
teeth,  and  we  know  that  they  had  some  priest  dentists,  for 
teeth  containing  gold  stoppings  have  been  found  in  mum- 
mies in  Egypt.  Some  diseases,  such  as  rickets,  scrofula,  and 
tubercle,  cause  early  decay  of  the  teeth.  But,  apart  from 
these  diseases,  there  is  no  doubt  that  cookery  is  largely 


282  TEETH,  CARE  OF 

responsible  for  decay  of  the  teeth;  the  more  simple  the 
national  diet  the  healthier  are  the  teeth.  Very  hot  drinks, 
such  as  hot  tea,  and  very  cold  food,  like  confectioners' 
ices,  play  havoc  with  the  teeth  and  crack  the  enamel. 
Long  ago,  when  races  ate  only  vegetables,  fruits,  and  nuts, 
we  believe  decayed  teeth  were  unknown ;  even  in  the  times 
of  the  Old  Testament  food  was  much  simpler  than  it  is 
now,  and  the  word  toothache  does  not  occur  in  it. 

It  Has  been  said  that  wherever  you  find  a  toothbrush 
you  will  find  decayed  teeth;  and  this  is  no  doubt  true; 
but  it  would  be  silly  to  say  the  former  caused  the  latter. 
When  a  race  becomes  developed  enough  to  indulge  in 
cookery,  hot  and  cold  foods,  vinegar,  etc.,  toothache  be- 
gins to  be  common,  and  doctors  become  common,  and  den- 
tists, too,  later  on.  Under  these  circumstances,  it  is  wise 
to  adopt  the  use  of  the  toothbrush,  and  also  certain  soft 
powders  and  disinfectant  liquids  may  be  suitably  used 
with  the  brush.  There  is  reason  to  fear,  however,  that 
much  of  the  tooth  powder,  consisting  mainly  of  chalk, 
which  has  been  retailed  the  last  fifty  years,  has  been  much 
too  gritty,  and  that  although  it  may  have  made  teeth  look 
clean,  it  may  have  worn  away  the  enamel  of  the  teeth  in 
places,  and  may  have  started  spots  of  decay. 

Liquid  teeth  washes,  containing  an  antiseptic,  such  as 
the  preparations  of  carbolic  acid,  are  the  most  safe. 
Dental  hospitals  for  the  poor  exist  now  in  England,  and 
parish  doctors  will  always  look  at  decayed  teeth,  remove 
them,  or  advise  what  is  best  to  be  done.  Decayed  teeth  are 
always  liable  to  ache,  and  are  a  source  of  danger  to  health. 
For  instance,  sickly  children  with  decayed  teeth  rarely  eat 
freely,  and  do  not  eat  enough,  because  the  mouth  is  so 
tender. 

It  is  the  fermentation  of  particles  of  food  lying  in  the 
spaces  between  the  teeth  which  gives  rise  to  acid  juices, 
which  corrode  the  enamel  surfaces  of  teeth,  and  lead  to 
spots  of  decay.  Careful  and  frequent  brushing  removes 
the  source  of  mischief.  An  excellent  plan  is  as  follows: 
— At  bedtime,  put  a  teaspoonful  of  bicarbonate  of  soda  in 
the  bedroom  tumbler  full  of  warm  water.  Soak  some 
pieces  of  white  silk  in  it.  Draw  the  strands  of  silk  be- 
tween the  teeth,  backwards  and  forwards  until  the  dis- 
colored patches  are  gone.  Then  brush  the  teeth  with  car- 
bolic tooth  powder.  If  a  tooth  is  healthy  when  it  is 


TETANUS  283 

cut  it  does  not  decay  from  within,  but  from  without  in- 
wards, because  of  the  decay  of  the  particles  of  food  which 
are  caught  in  the  cracks  of  the  enamel. 

The  early  stage  is  painless,  but  at  last  in  each  case  there 
comes  a  day  when  the  erosion  by  decay  opens  into  the 
natural  space  within  the  tooth,  exposes  the  delicate,  sensi- 
tive nerve,  and  toothache  begins,  and  will  continue  to  be 
felt  either  continuously  or  at  intervals  until  the  whole  of 
the  sensitive  pulp  is  dead. 

Even  then  the  danger  of  toothache  still  exists,  because 
little  abscesses  may  form  at  the  deep-seated  ends  of  the 
fangs  of  the  tooth,  and  it  is  then  that  the  sufferers  rush 
at  last  to  the  doctor  or  the  dentist  for  immediate  relief  by 
extraction. 

The  teeth,  then,  are  of  so  much  value  to  health  that 
everyone  should  pay  the  utmost  attention  to  them. 

There  is  always  an  early  stage,  when  the  affected  tooth 
may  be  saved  for  a  time,  if  carefully  stopped  by  a  dentist; 
but  this  stage  is  easily  passed  by,  and  then  there  only  re- 
mains the  cure  of  the  pain  by  having  the  tooth  taken  out. 
(See  also  "Dental  Hygiene.'7) 

Tetanus  (Lock-jaw). — Tetanus  is  a  disease  which  occurs 
most  commonly  from  Fourth  of  July  accidents,  and  as  a 
result  of  wounds  made  with  dirty  or  rusty  instruments  or 
nails. 

It  is  nhie  to  a  germ  found  most  commonly  in  the  soil 
and  about  stables,  which  enters  the  body  through  wounds 
which  may  sometimes  be  so  small  they  are  hardly  noticed. 
The  most  dangerous  wounds  are  the  small  deep  ones,  such 
as  those  made  by  nails,  and  the  wounds  from  firecrackers 
and  toy  pistols. 

The  toxin  manufactured  by  the  tetanus  germ  is  three 
hundred  times  as  strong  as  strychnine.  It  poisons  the 
nervous  system  and  causes  all  the  muscles  to  be  thrown 
into  contraction.  One  of  the  first  symptoms  of  tetanus  is 
a  stiffness  of  the  muscles  of  the  jaw  and  neck. 

When  a  wound  is  made  by  a  dirty  instrument — a  nail, 
a  firecracker  or  a  toy  pistol — extraordinary  precautions 
should  be  taken  to  disinfect  the  wound,  using  peroxide 
of  hydrogen,  potassium  permanganate  solution,  followed 
by  bichloride  of  mercury  solution.  Copious  bleeding  of 
a  wound  helps  to  wash  out  the  poisonous  products. 

An  antitoxin  for  tetanus  has  been  prepared,  but  it  is 


284  TOBACCO 

of  more  use  in  preventing  the  disease  than  curing  it.  As 
a  result  of  the  use  of  this  antitoxin  the  deaths  from  tetanus, 
following  an  almost  equal  number  of  Fourth  of  July  in- 
juries (about  4500),  were  reduced  from  406  in  1903,  to 
62  in  1907.  Observance  of  the  "safe  and  sane"  Fourth 
in  recent  years  has  still  further  reduced  the  amount  of 
death  and  injury  resulting  at  this  time  of  the  year. 

Tobacco;  Ought  we  to  Smoke  it? — Let  us  say  in  answer 
to  our  own  question — Yes.  So  long  as  we  smoke  in 
moderation,  and,  at  suitable  times,  and  do  not  annoy  other 
people  by  our  smoking,  there  seems  no  good  reason  why 
we  should  not  smoke.  Given  as  a  drug,  tobacco  does 
weaken  the  heart  and  depress  the  nervous  system.  In 
smaller  doses  it  only  quiets  the  heart  and  soothes  the 
nerves.  So  it  has  its  uses,  as  everybody  knows.  No  one 
wishes  to  defend  its  abuse.  If  a  young  man  finds  he  has 
flabby,  cold  hands,  he  is  very  likely  smoking  too  much; 
but  what  may  be  excess  for  him  may  be  only  moderation 
for  somebody  else.  A  smoke  often  makes  one  feel  more 
comfortable  in  mind  and  body,  but  the  feeling  of  well- 
being  is  not  accompanied  by  a  desire  for  activity  (except 
in  a  few  people  who  write),  but  by  a  desire  to  stay  as 
long  in  the  easy-chair  as  possible!  So  we  ought  to  smoke 
only  when  work  is  done.  Many  people  who  suffer  from 
''sick  headache,"  or  migraine,  as  doctors  call  it,  find  that 
tobacco  is  a  wonderful  means  of  getting  relief;  but  others 
do  not  get  sick  headache  until  they  have  smoked  too  much. 
"What  is  one  man's  meat  is  another  man's  poison,"  says 
the  old  proverb.  People  will  certainly  keep  on  smoking  in 
spite  of  cranks  of  all  kinds,  and  in  spite,  even,  of  certain 
scientific  investigations  which  go  to  prove  that  it  does  no 
one  any  particular  good,  and  many  people  much  harm. 
The  pipe  is  the  best  way  of  smoking  tobacco,  and  the  sea- 
soned clay  pipe  is  the  sweetest  smoke  of  all.  Yet  the 
stem  of  the  clay  is  hot,  and,  in  certain  people,  leads  to 
ulcers  and  sores  of  the  lips  and  tongue.  The  stronger  the 
man  the  stronger  the  tobacco  he  can  stand;  but,  also,  the 
more  he  is  likely  to  go  to  excess.  After  all,  men  will  do 
something  or  other  to  excess,  and  excess  of  smoking  does 
far  less  social  damage  than  excess  of  alcohol.  Cigarette 
smoking  is  generally  rather  prejudicial,  and  all  smoking  is 
likely  to  be  harmful  when  inhaling  is  indulged  in.  Egypt- 


TOE-NAIL  INGROWING  285 

ian  and  Turkish  cigarettes  are  apt  to  contain  niter,  to  make 
them  taste  strong.  They  often  cause  headaches.  Cigars 
of  good  quality  are  free  from  much  objection,  but  few 
can  afford  a  good  cigar.  In  tobacco-growing  countries  one 
can  get  a  good  weed  for  about  2  cents,  but  here  no  cheap 
cigar  is  worth  smoking.  Many  cigars  are  innocent  of  to- 
bacco, and  are  made  of  dock  leaves,  or  rhubarb  leaves,  or 
dandelion;  and  are  flavored  with  tobacco  juice.  Such 
cigars  are  smoked  only  for  effect.  They  taste  like  what 
they  are — imitation  tobacco;  and  the  buyer  does  not  gen- 
erally want  to  buy  any  more  of  them,  if  he  can  procure 
tobacco  in  some  other  form. 

Toe-Nail  Ingrowing. — This  is  a  very  painful  and  rather 
troublesome  affection,  caused  by  wearing  boots  too  narrow 
across  the  toes.  The  soft  flesh  and  skin  at  the  side  of 
the  big-toe  nail  is  pressed  upon  by  the  boot  and  made  to 
overlap  the  edge  of  the  nail.  The  nail  does  not  grow  into 
the  flesh,  however,  but  causes  a  sore  place  where  the  flesh 
is  pressed  against  a  sharp  edge  of  the  nail.  The  ulcer 
formed  is  often  troublesome  when  the  feet  have  not  been 
kept  clean. 

In  mild  cases,  a  good  plan  is  to  scrape  the  nail  down  the 
middle  with  a  knife  or  piece  of  broken  glass,  until  it  is 
hardly  thicker  than  a  sheet  of  paper.  Then,  all  dirt  or 
horny  skin  should  be  removed  from  under  the  nail.  Then, 
a  notch  should  be  cut  in  the  middle  of  the  free  edge.  These 
measures  help  the  edges  to  curl  up  somewhat  and  take  them 
away  from  the  flesh.  But  if  tight  boots  are  not  worn,  and 
if  the  edge  of  the  nail  is  not  cut  square,  the  toe-nail 
trouble  will  never  arise.  The  first  essential,  then,  is  to 
wear  roomy  boots  with  squarish  toes. 

In  very  bad  cases  of  ingrowing  toe  nails,  there  is  only 
one  really  satisfactory  treatment,  and  that  is  removal  of 
the  whole  nail.  This  can  be  done  by  a  surgeon,  or  at  a 
hospital.  Short  of  this  radical  cure  there  are  several  modes 
of  treatment,  of  which  we  give  two.  One  comes  from  Ger- 
many. The  plan  is  to  put  a  fragment  of  cork  under  the 
edge  of  the  nail  where  it  appears  to  be  growing  into  the 
flesh.  Then  pour  ten  drops  of  strong  solution  of  ferric 
chloride  on  to  the  ulcer  and  edge  of  the  nail,  let  it  dry 
on,  and  repeat  the  process  every  day  for  five  days.  A 
blackish  crust  forms  and  the  nail  becomes  so  brittle  that  it 


286  TONGUE,  DISEASES  OF 

can  be  scraped  away  easily.  Then  the  sore  may  be  healed 
up  with  a  little  iodoform  ointment,  and  wider  boots  must 
be  worn. 

The  other  plan  is  quicker  and  rather  cleaner.  Get  a  50 
per  cent,  solution  of  caustic  potash  (or  caustic  soda),  warm 
some  of  it,  and  moisten  the  nail  with  it.  This  softens  the 
nail  and  the  soft  part  may  be  scraped  away  with  a  piece 
of  clean  broken  glass.  Then  drop  a  little  more  caustic 
on  to  it  and  scrape  away  until  the  nail  is  as  thin  as  paper. 
Then  the  offending  part  of  the  nail  may  be  easily  removed 
with  nail  scissors.  This  is  a  very  good  method  when  deal- 
ing with  old  horny  tough  nails  such  as  are  found  on  the 
feet  of  old  men  and  women  of  the  laboring  class. 

Tongue,  Diseases  of. — The  tongue  has  its  own  special  dis- 
eases, such  as  inflammation,  ulceration,  and  cancer,  and 
may,  of  course,  suffer  from  injuries,  such  as  scalding,  or 
it  may  be  bitten  during  fits,  especially  epileptic  fits. 

The  tongue  has  its  minor  ailments  also,  and  its  appear- 
ance varies  so  greatly  from  day  to  day  during  the  course 
of  general  diseases  that  it  has  been  looked  on  from  time 
immemorial  as  the  guide  to  a  person's  state  of  health. 
Medical  knowledge  has  made  immense  strides  during  the 
last  50  years,  but  the  state  of  the  tongue  still  remains  one 
of  the  most  important  guides  to  the  progress  of  a  disease. 

The  tongue  of  a  healthy  person  is  pink,  soft,  moist,  and 
clean;  that  is  to  say,  it  is  not  covered  with  any  "fur," 
or  deposit  of  a  white,  gray,  or  brown  color.  It  is  ex- 
tremely important  that  the  tongue  should  be  moist,  for 
if  it  be  dry  it  causes  much  discomfort,  and  sense  of  taste 
is  lost. 

The  tongue  is  discolored  and  covered  with  fur  whenever 
there  is  any  form  of  indigestion,  and  also  during  all  states 
of  fever. 

Another  tongue  symptom  is  that  of  being  in  a  state  of 
tremor;  it  trembles  when  it  is  put  out,  and  the  patient  is 
quite  unable  to  hold  it  steady.  This  is  one  of  the  symptoms 
of  delirium  tremens,  and  is  the  result  of  poisoning  by 
alcoholic  drinks.  The  absinthe  so  much  drunk  in  Paris  is 
especially  liable  to  cause  this  ailment. 

Palsy  may  also  affect  one-half  or  the  whole  of  the 
tongue,  and  this  is  usually  one  of  the  results  of  a  severe 
apoplectic  attack,  which  brings  on  paralysis  of  either  the 
right,  or  left  limbs. 


TOOTHACHE  287 

Pallor  of  the  tongue — a  loss  of  its  rosy  pink  tint — is 
seen  in  the  course  of  anaemia,  so  common  in  young  women ; 
and  in  debility  the  tongue  becomes  swollen,  soft  and  flabby, 
so  that  at  its  side  you  may  see  the  marks  where  it  lies 
against  the  teeth. 

White  furred  tongue  is  seen  in  rheumatic  and  other 
fevers,  also  dyspepsia  and  congestion  of  the  liver,  and  all 
stomach  ailments.  All  who  drink  too  freely  are  liable  to 
have  the  tongue  furred,  and  smokers  generally  have  a 
dirty  white  tongue. 

A  bright  red  tongue  is  seen  in  scarlatina,  and  red  dry 
tongue  marks  the  end  of  fatal  diseases,  such  as  phthisis 
and  pyaemia.  A  dry  brown  tongue  is  a  sign  of  great  ex- 
haustion, such  as  seen  in  typhoid  and  typhus  fevers  and  in 
cases  of  blood-poisoning.  When  patients  are  recovering, 
the  tongue  gradually  loses  its  fur,  and  regains  its  proper 
color  and  moisture,  much  to  the  relief  of  the  sufferer. 

We  may  mention  that  in  many  illnesses  in  which  the 
tongue  is  furred  it  may  be  "cleaned"  for  a  time,  with  bi- 
carbonate of  soda  solution  and  a  clean  towel.  This  often 
gives  a  great  sense  of  comfort  to  the  sick  man.  Lemon 
juice  may  be  used  if  soda  fails  to  clean  it. 

Too  Fat.—  (See  "Corpulence.") 

Toothache. — This  is  a  sign  of  some  local  trouble  in  one 
or  more  of  the  teeth,  or  in  the  jaw,  and  must  be  dis- 
tinguished from  neuralgia  of  the  face,  though  neuralgia 
is  often  caused  at  first  by  the  irritation  of  decayed  teeth. 
If  the  pain  is  made  worse  by  hot  or  by  cold  water  in  the 
mouth,  probably  the  tooth  is  decayed  and  the  nerve  pulp  is 
exposed.  The  proper  thing  to  do  then  is  to  syringe  the  hol- 
low tooth  out  carefully  and  gently  with  warm  water  and 
to  put  into  it  afterwards,  without  any  pressure,  a  little 
plug  of  cotton  wool  steeped  in  creosote,  or  oil  of  cloves,  or 
cocaine  dissolved  in  oil  of  cloves.  If  the  pain  is  due  to 
inflammation  in  the  pulp  cavity  (i.e.,  inside  a  tooth)  no 
relief  will  be  obtained  till  the  pus  can  get  out,  and  a  visit 
to  the  dentist  should  be  made. 

If  all  the  gums  around  are  swollen  and  tender,  the  neces- 
sity of  a  dental  surgeon's  advice  is  all  the  greater.  What- 
ever you  do,  do  not  be  beguiled  into  trying  to  "cure" 
your  toothache  with  any  of  the  so-called  "neuralgia  cures." 
They  will  be  useless  while  the  local  state  of  things  in  the 
mouth  is  unattended  to.  It  would  be  difficult  to  overrate 


288  TRADE  DISEASES 

the  importance  of  keeping  the  teeth  in  order.  Decayed 
teeth  are  really  little  nests  of  disease  germs  and  may  cause 
consumption,  enlarged  glands,  indigestion,  ear  disease,  fits, 
&c.,  &c. 

Trade  Diseases. — There  are  certain  trades  and  occupa- 
tions which  have  important  relations  to  certain  diseases, 
which  are  therefore  grouped  together  here  under  the  above 
heading. 

I. — Lead  poisoning. — All  workers  in  lead,  such  as  fac- 
tory hands  in  lead  works,  painters,  compositors,  plumbers, 
glass  and  pottery  polishers,  and  white  lead  makers,  are 
liable  to  suffer  from  a  group  of  symptoms  caused  by  the 
absorption  of  lead  into  their  systems.  Lead  may  also  be 
taken  into  the  body  in  poisonous  quantities  in  drinking 
water  contaminated  by  lead  pipes,  in  cider,  or  in  tinned 
fruits. 

It  is  the  lead  glazers  who  chiefly  are  liable  to  lead  poison- 
ing, as  they  inhale  dry  lead  salts. 

Symptoms. — Early  signs  are  muscular  weakness,  debility, 
and  pallor  of  the  skin.  Then  follow  some  or  all  of  these 
symptoms: — A  blue  line  along  the  gums,  absent  where  the 
teeth  have  fallen  out  and  often  absent  in  those  who  clean 
the  teeth  regularly.  Colic  and  constipation,  generally  very 
painful  indeed,  and  lasting,  sometimes,  several  days. 
Wrist-drop  and  foot-drop — the  muscles  which  should  hold 
up  the  wrist  and  foot  respectively  become  paralyzed.  Con- 
vulsions and  violent  headaches  may  occur.  Anosmia,  and 
all  its  consequences.  Kidney  disease,  with  scanty  urine. 

Treatment. — In  lead  works  the  foremen  generally  know 
what  to  do  when  there  are  signs  of  lead  poisoning  in  any 
of  the  workers.  Colic  is  to  be  dealt  with  by  hot  fomenta- 
tions and  morphine  injections,  which  the  doctor  will  give 
with  his  hypodermic  syringe.  (See  also  "Lead  poison- 
ing.") 

II. — Arsenic  poisoning. — Those  who  work  at  arsenic  ore 
smelting,  and  in  factories  of  wall  paper,  and  elsewhere, 
all  are  liable  to  suffer  from  arsenic  poisoning.  The 
symptoms  are  those  of  multiple  neuritis — vague  pains  and 
tingling  in  the  limbs,  weakness  and  wasting  away  of  the 
calves  and  thighs,  wrist-drop,  and  * '  dropped  foot, ' '  hoarse- 
ness, squinting,  and  tenderness  of  the  calf  muscles.  In 
addition  to  these  there  may  be  cough,  diarrhea,  eczema, 
headache  and  trembling. 


TRAINING  289 

If  the  patient  gets  away  from  the  source  of  all  the  mis- 
chief, namely,  the  arsenic,  he  will  get  well.  Otherwise,  he 
will  not. 

III. — Phosphorus  poisoning. — The  fumes  of  phosphorus 
are  apt  to  affect  those  who  work  in  match  factories  where 
the  yellow  form  of  phosphorus  is  in  use. 

These  workers  are  liable  to  have  "phossy  jaw,"  which 
is  a  local  disease  of  the  jawbone  due  to  the  irritation  of 
phosphorus  which  has  got  in  through  a  hollow  decayed 
tooth.  All  factory  hands  should  take  special  care  of  their 
teeth.  Special  medical  treatment  is  necessary. 

IV. — Mercurial  poisoning  occasionally  occurs  in  felt-hat 
makers  in  which  occupation  mercury  nitrate  is  often  used. 
Sometimes  a  man  gets  an  inflamed  mouth  while  dosing 
himself  with  mercury  for  syphilis.  The  treatment  for 
this  is  to  stop  the  mercury  for  a  time  and  suck  chlorate  of 
potash  lozenges  continually. 

V. — Among  other  diseases  caused  by  occupations  are — 
aneurism,  to  which  laborers  and  porters  are  liable;  'bron- 
chitis, emphysema  and  deafness,  from  which  glass  blowers 
often  suffer;  sore  throat  of  a  special  type,  common  among 
the  clergy;  fibroid  consumption  of  the  lungs,  set  up  by 
irritating  particles  of  metal,  is  common  among  flax-workers, 
iron-workers,  steel  grinders  and  millers. 

VI. — Special  forms  of  nervous  cramps  and  paralysis 
occur  among  typewriters,  clerks,  and  telegraphists.  Miners 
are  liable  to  suffer  from  jerkiness  of  the  eyeballs,  and 
shoemakers  and  tailors  and  leather-workers  sometimes  get 
wry-neck  of  a  spasmodic  kind  from  sitting  too  long  in  one 
attitude. 

Training. — As  our  object  in  this  book  is  to  be  of  use  to 
as  many  of  our  readers  as  we  possibly  can,  we  feel  it  our 
duty  to  say  something  on  the  subject  of  athletic  training. 
The  object  of  training  is  to  bring  about  the  development 
of  the  highest  degree  of  activity  and  endurance  and 
strength  possible  to  the  human  body.  Some  loss  of  stored- 
up  material  (principally  fat)  always  takes  place  in  this 
process;  and  so,  if  it  be  carried  too  far,  the  athlete  is  at 
last  weakened  and  is  then  said  to  be  overtrained. 

Training  consists  in  a  combination  of  dieting  and  ex- 
ercise, and  takes  about  six  weeks  to  accomplish.  The 
muscles  get  harder,  the  whole  skin  improves  in  appear- 
ance and  the  athlete  feels  more  and  more  "fit"  every 


290  TRAINING 

day.  The  change  from  ordinary  feeding  to  a  training  diet 
should  be  gradual  and  not  sudden.  A  diet  consisting 
largely  of  lean  meat  is  necessary,  but  this  reminds  us 
that  no  one  ought  to  be  allowed  to  undertake  "training" 
on  these  lines,  or  to  enter  for  feats  of  endurance  or 
strength,  if  he  is  over  35  years  of  age,  or  if  he  is  gouty 
in  tendency.  But  no  really  sensible  man  begins  training 
without  having  had  himself  "overhauled"  first  by  the 
family  doctor. 

The  diet  then  is  to  be  roast  or  grilled  underdone  beef 
and  mutton,  with  a  moderate  allowance  of  vegetables  and 
bread.  All  entrees  and  pastry  and  puddings  and  sweets 
are  absolutely  forbidden.  So  are  all  sauces,  condiments, 
and  pickles,  for  their  only  use  is  to  increase  artificial 
appetite. 

The  drink  allowance  is  to  be  limited,  and  there  is  to  be 
no  allowance  of  spirits;  occasionally,  a  very  light  dry 
Rhenish  wine  may  be  taken.  Toast-and-water,  barley 
water,  cocoa,  tea  and  coffee  are  to  be  the  beverages.  There 
are  to  be  three  meals  a  day.  We  append  below  the  schemes 
of  training  which  are  adopted  at  Oxford  and  Cambridge 
Universities  for  the  inter-university  boat  race  every  sum- 
mer. As  to  exercises,  we  can  say  little;  no  one  will  be 
able  to  train  quite  satisfactorily  without  personal  advice 
from  a  trainer;  we  can  only  suggest  the  dietary. 

A  day's  training  for  the  boat  races.  (Summer.) — (By 
Dr.  Maclaren) : — 

CAMBRIDGE— 

A  run  of  100  or  200  yards,  as  fast  as  possible. 
Breakfast. — Underdone  meat,  dry  toast,  two  cups  of 

tea,  watercress  occasionally. 
2  P.  M. — Meat  as  at  breakfast,  bread,  potatoes,  greens. 

One  pint  of  beer.     Dessert,  oranges,  or  biscuits 

and  figs,  1  vo  glasses  of  wine. 
"Rowing  exercise  during  late  afternoon. 
8 :30  P.  M. — Cold  meat,   bread,   lettuce  or  watercress, 

one  pint  of  beer. 
10  P.  M. — Retire  to  bed. 

OXFORD— 

7  A.  M. — Rise.     A  short  walk  or  run. 
8:30 — Breakfast. — Underdone  meat,  crust  of  bread  or 
dry  toast,  tea  (as  little  to  be  drunk  as  possible). 


TUBERCLE  291 

2  P.  M. — Dinner. — Meat,  bread,  no  vegetables  (not 
strictly  adhered  to),  one  pint  of  beer. 

5  :30 — Rowing  exercise. 

8:30 — Supper. — Cold  meat,  bread,  sometimes  water- 
cress, one  pint  of  beer. 

10  P.  M. — Retire  to  bed. 

It  will  be  observed  that  at  both  the  universities  the  un- 
dergraduates take  two  pints  of  beer  daily  during  train- 
ing. Professional  trainers  and  professional  athletes  are 
mostly  teetotal;  and  it  yet  remains  to  be  proved  whether, 
even  for  young  fellows,  undergoing  training  for  special 
events  like  the  boat  race,  it  would  not  be  much  better  if 
they  adopted  a  training  diet  which  excluded  alcohol  alto- 
gether. 

Tubercle. — A  tubercle  is  a  little  tiny  granule  (in  some 
organ  such  as  the  lung),  made  of  a  collection  of  cells  which 
have  gathered  together  to  try  and  limit  the  poisonous 
effects  of  one  or  more  tubercle  bacilli,  or  germs,  which  oc- 
cupy the  center  of  the  tubercle.  The  bacilli  are  breathed 
into  the  lungs  (for  example),  find  that  there  is  a  suitable 
place  for  them  to  grow  in,  and  begin  to  multiply  as  fast 
as  they  can.  From  that  moment  the  person  becomes 
"tuberculous."  But  his  resisting  power  may  be  so  great 
that  the  germs  are  surrounded  by  cells  which  soon  cut 
them  off  from  all  nourishment,  and  then  they  die ;  and  the 
place  where  they  had  found  a  temporary  lodging  turns 
into  a  sort  of  cheesy  mass  which  is  harmless.  Then  the 
person  is  said  to  be  cured  of  his  tuberculous  disease.  Too 
frequently,  however,  there  are  some  bacilli  left,  which  only 
await  their  opportunity  to  start  a  fresh  patch  of  disease, 
whenever  the  person  gets  run  down.  There  are  hundreds 
and  thousands  of  people  who  are  exposed  to  the  tubercle 
bacilli  in  the  air  every  day  of  their  lives.  Hundreds  of 
them  become  infected  over  and  over  again,  and  get  rid 
of  it  by  a  natural  cure.  Many  a  person  with  a  bad  cough 
has  a  small  infection  of  tubercle,  which  he  will  presently 
get  cured  of.  Every  person  with  even  bad  tuberculous 
disease  may  hope  that  he  will  get  into  a  stage  of  quiescence, 
which  is  about  the  best  that  can  be  hoped  for.  If  a  case 
of  tuberculous  disease  is  taken  early  and  treated  well,  there 
may  be  a  complete  cure;  but,  too  often,  the  damage  done 
to  the  organ  affected  only  admits  of  "quieting"  and  not 
curing  the  disease. 


292  TYPHOID  FEVER 

Tumor. — The  word  tumor  means  a  swelling,  and  nothing 
more  than  that.  But  the  word  is  applied  not  so  much  to 
diffuse  and  generalized  swelling  (such  as  occurs  on  a 
shoulder  after  a  severe  bruising,  for  instance),  but  to 
"lumps"  or  "knobs"  of  any  sort  caused  by  inflammation 
or  by  the  growth  of  "new  tissue,"  such  as  cancer.  A 
tumor  which,  if  it  were  removed,  would  not  be  replaced  by 
another  of  the  same  type,  is  called  a  benign  tumor.  Such 
are  fatty  tumors,  birth-marks  or  naevi,  bony  knobs,  cysts 
(wens),  and  fibrous  growths,  like  warts. 

A  tumor  which,  if  removed,  would  only  be  replaced  by 
another  of  the  same  type,  and  which,  if  left  alone,  would 
ulcerate  and  cause  the  patient's  death,  is  called  a  malignant 
tumor.  Such  are  all  the  forms  of  cancerous,  and  sarcoma- 
tous  growths. 

Typhoid  Fever. — Although  this  disease  is  less  often  found 
in  an  epidemic  form  than  it  used  to  be,  before  the  drain- 
age of  our  towns  was  carried  out  so  efficiently,  yet  it  is 
still  a  very  common  ailment  in  solitary  cases.  It  is  gen- 
erally spread  through  the  contamination  of  drinking  water, 
or  milk,  or  oysters,  or  by  the  rise  of  sewer  gases  from 
drains  or  sinks  into  our  dwelling  houses.  It  is  but  very 
slightly  infectious  in  ordinary  ways,  and  cannot  be  caught 
from  the  breath  of  a  patient,  and  only  from  touching  a 
sufferer  when  the  skin  has  been  soiled  by  discharges.  Even 
those  who  nurse  cases  of  this  disease  very  rarely  become 
infected. 

Cases  of  typhoid  fever  vary  very  much  in  severity;  a 
few  persons  are  able  to  keep  up  most  of  the  time,  but  the 
majority  of  those  who  have  it  need  to  remain  in  bed  for 
four  or  more  weeks.  Children  seem  to  suffer  less  severely 
than  adults;  both  sexes  are  affected,  and  young  adults 
generally  have  the  most  severe  attacks.  It  attacks  rich 
and  poor  almost  equally,  and  it  may  so  lower  the  vitality 
that  although  a  patient  may  recover  from  it,  he  often, 
soon  after,  goes  off  into  consumption.  On  the  other 
hand,  many  people,  on  recovering  from  typhoid  fever,  get 
better  and  stronger  than  they  ever  were  before;  and  some 
consumptives  get  quite  cured  of  their  consumption  by  an 
attack  of  typhoid  fever.  This  disease  is  sometimes  called 
enteric  fever,  because  it  causes  local  affections  in  the  bowels. 
It  is  in  our  times  the  great  scourge  of  armies,  especially 
in  war-time.  In  this  country  it  is  most  prevalent  in  the 


TYPHOID  FEVER  293 

autumn  of  the  year  and  wet  seasons.  When  one  case  is 
caught  from  another,  a  period  of  10  to  14  days  elapses  be- 
fore the  onset  of  symptoms.  This  is  called  the  incubation 
period  of  the  disease.  It  is  slow  in  developing,  unseen 
and  generally  unsuspected.  It  is  a  disease  attended  by  a 
form  of  fever,  continuous,  but  generally  not  of  a  violent 
type. 

The  ailment  begins  with  a  period  of  debility  and  languor, 
with  loss  of  appetite  and  nausea,  then  follow  headache,  chills, 
thirst,  and  pains  in  the  back  and  limbs,  with  a  tendency  to 
diarrhea  without  much  colic  pain;  about  two  degrees  of 
fever  in  the  mornings  and  three  to  four  degrees  in  the 
evenings.  The  patient  is  restless,  and  often  sleepless.  This 
fever  may  continue  for  three  weeks,  and  in  such  cases  the 
weakness  becomes  extreme,  the  tongue  dry  and  brown,  and 
there  may  be  extreme  diarrhea,  and  even  blood  may  be 
passed,  which  comes  from  ulcerations  of  the  bowels.  In 
a  considerable  number  of  cases  there  is  a  slight  rash  of 
pink  dots  on  the  skin  of  the  chest  and  body.  These  rosy 
spots  are  most  noticeable  on  the  belly,  and  come  out  in 
crops,  some  fading  while  others  are  appearing.  These 
symptoms  may  gradually  pass  off,  and  recovery  will  follow, 
but  in  severe  cases  they  lead  on  to  fatal  exhaustion,  ac- 
companied by  delirium,  insensibility,  and  convulsions.  No 
drug  has  any  power  to  cure  the  disease,  and  the  doctor  can 
only  give  medicines  to  relieve  serious  symptoms  as  they 
arise. 

But  it  is  useless  to  attempt  to  treat  the  disease  without 
medical  aid.  It  has  been  well  studied  and  is  well  under- 
stood. A  large  proportion  of  all  cases  recover.  The  chief 
hope  of  the  patient  is  in  the  excellence  of  the  nursing. 
The  nurse  must  daily  examine  the  "stools"  (the  matter 
passed  by  the  bowels),  and  must  be  on  the  look-out  for  un- 
digested lumps  of  curdled  milk.  The  diet  must  be  milk 
(if  it  agrees),  chicken  broth,  barley  water,  and  so  on. 
Beef  tea  is  not  much  use,  especially  as  it  tends  to  bring 
on  diarrhea.  Alcohol  may  be  needed  in  the  later  stages 
when  the  heart  is  weak. 

The  disease,  as  we  have  said,  requires  real  skill  and 
medical  treatment;  the  nurse  must  have,  always  ready, 
broken  ice,  hot  water,  castor  oil,  a  water-bed  for  the  patient 
to  lie  on;  and  she  must  be  on  the  look-out  for  bedsores, 
which  are  very  apt  to  form.  (See  ' '  Bedsores. ' ' )  Lastly  and 


294  ULCERS 

most  important,  she  must  keep  a  plentiful  supply  of  dis- 
infectants and  put  some  into  every  stool  and  every  vessel 
used  by  the  patient.  (See  "Infection.") 

Note  that  no  solid  food  must  be  given  to  any  typhoid 
patient  till  the  temperature  of  the  body  has  been  normal 
for  at  least  a  week  or  ten  days.  To  give  solid  food  other- 
wise is  to  kill  the  patient. 

Prevention  of  Typhoid  Fever. — Typhoid  fever  can  be  pre- 
vented in  one  of  three  ways  (the  three  combined  are  prefer- 
able) :— 

1st.    Destroy  the  infectious  agent  at  its  source. 

2nd.  Destroy  the  means  of  transmission. 

3rd.  Avoid  infection. 

(1)^  The  infectious  agent  always  proceeds  from  a  case  of 
typhoid  fever.  Therefore  disinfect  all  secretions  and  ex- 
cretions from  a  typhoid  case  by  the  use  of  freshly  slaked 
lime  or  chloride  of  lime.  Dispose  of  these  in  such  a  way 
that  they  cannot  contaminate  a  water  or  milk  supply.  Do 
not  allow  utensils  or  furnishings  in  a  typhoid  case's  room 
to  be  used  by  anyone  else  until  they  have  been  thoroughly 
sterilized  or  disinfected. 

Remember  there  is  danger  of  a  "typhoid  carrier's"  trans- 
mitting the  disease  through  excretions  a  long  time  after 
recovery  from  the  disease.  Absence  of  the  germ  from  the 
excretions  can  only  be  determined  by  a  bacteriological  ex- 
amination. 

(2)  Pasteurize  all  milk  drunk  and  filter  or  boil  all  water. 
Destroy  flies  or  prevent  their  breeding.     Do  not  empty  raw 
sewage  into  water  supplies  used  for  drinking  or  bathing. 

(3)  Avoid    infection    by    having    yourself    immunized 
against  typhoid  by  preventive  inoculation.     Any  first  class 
physician  can  do  this. 

Do  not  drink  any  but  pasteurized  milk  unless  you  know 
its  source  to  be  free  from  danger  of  typhoid.  (Very  few 
are.) 

Do  not  eat  any  but  deep-sea  oysters,  unless  cooked. 

Prevent  the  access  of  flies  to  your  food. 

Do  not  bathe  in  sewage-polluted  water. 

Keep  your  body  in  robust  condition. 

Ulcers. — The  common  word  for  ulcer  is  "sore,"  and,  of 
course,  there  are  a  very  great  many  varieties  of  sore.  (For 
ulcer  of  stomach  and  perforated  ulcer,  see  "Stomach  Dis- 
eases"; ulcer  of  back,  see  "Bedsores";  ulcerated  throat, 


ULCERS  295 

see  "Sore  Throat";  syphilitic  ulcer,  see  " Syphilis";  scrofu- 
lous ulcer,  see  "Tubercle"  and  "Consumption";  eczema- 
tous  ulcer,  see  "Eczema.")  The  treatment  of  every 
different  type  of  ulcer  is  different,  and  this  fact  makes  it 
necessary  for  us  to  describe  each  of  the  more  common  kinds 
of  ulcer,  so  that  the  reader  may  know  what  sort  of  ulcer  he 
has  before  he  begins  to  treat  it.  We  hope  that  these  re- 
marks will  be  of  the  highest  value  to  our  poorer  readers 
who  suffer  so  much  from  ulcerated  legs,  who  grudge  the 
money  that  the  advice  of  a  good  medical  man  naturally 
costs,  and  who  are  too  apt  to  waste  their  money  in  buying 
ointments  which  are  said  to  cure  all  ulcerated  legs!  No 
one  ointment  can  possibly  be  good  for  all  the  different 
kinds  of  ulcers,  and  some  ulcers  want  no  ointment  at  all. 

(1)  The  Healthy  ulcer. — The  skin  round  it  is  not  swollen 
or  boggy,  or  discolored;  there  is  no  change  in  it  beyond  a 
ring  of  pinkness  immediately  round  the  sore.  The  edges 
of  the  sore  are  rounded,  shelving  gently  down  to  the  sore, 
and  are  opaque  white  at  the  very  margin,  bluish  nearer  to 
the  middle  and  dark  red  at  the  center  of  the  sore.  The  dis- 
charge, if  any,  is  like  white  of  egg  in  appearance.  There 
is  no  pain,  no  tenderness.  It  is  the  object  of  our  treatment 
to  bring  all  ulcers  to  this  condition. 

Treatment. — Rest,  and  any  cleanly  dressing  are  all  that 
are  needed.  The  ulcer  will  heal  of  itself  in  good  time. 

Now  with  regard  to  REST,  we  must  say  that  it  is  the  most 
important  thing  of  all  in  the  treatment  of  every  kind  of 
ulcer.  Few  people  will  take  to  bed  for  the  sake  of  healing 
a  small  sore  which  is  giving  little  trouble,  but  many  a 
woman's  whole  life's  misery  would  have  been  saved  if  she 
had  only  treated  her  ulcerated  leg  with  rest  in  bed  while 
it  was  not  a  serious  matter!  By  those  who  can  afford  a 
proper  surgical  dressing  for  the  ulcer,  the  following  in- 
structions may  be  followed: — A  piece  of  perfectly  clean 
lint,  exactly  the  size  of  the  sore,  is  moistened  with  a  con- 
centrated solution  of  boric  acid  and  laid  on  the  ulcer.  It 
is  covered  with  a  piece  of  oiled  silk  which  overlaps  the  lint 
all  round;  uniform  pressure  is  applied  by  a  bandage  and 
the  dressing  is  changed  once  a  day. 

Whatever  mode  of  treatment  be  adopted  for  an  ulcer  on 
the  leg,  rest  in  bed,  with  the  limb  raised,  has  more  influence 
than  any  other  condition  in  hastening  the  cure. 

Sometimes,  even  in  a  healthy  ulcer,  there  is  so  much  loss 


296  ULCERS 

of  tissue,  that  if  we  are  to  wait  " until  it  skins  over"  we 
shall  have  to  wait  a  very  long  time.  In  these  cases  sur- 
geons graft  some  flakes  of  skin  from  other  parts  of  the  body, 
and  the  transplanted  skin  grows  well  in  its  new  situation. 

(2)  The  weak  ulcer. — This  is  often  the  result  of  too  much 
watery  poulticing.     The  edges  are  not  definite  and  the  ulcer 
has  no  opalescent  blue  ring  like  the  healing  ulcer  has.     The 
granulations   (the  pinkish  granular  flesh  of  the  sore)   are 
pale,  flabby  and  exuberant,  and  have  a  watery  discharge. 
Old  nurses  call  the  ulcer  " proud  flesh." 

Treatment. — This  is,  in  one  word,  stimulation.  The  pa- 
tient wants  nourishing  food,  rest  in  bed,  pure  air,  and  a 
tonic.  The  ulcer  has  to  be  dressed  often,  washed  with  red 
wash,  and  a  little  piece  of  lint  the  same  size  as  the  ulcer 
is  to  be  dipped  in  the  wash  and  always  kept  on  the  ulcer. 
The  flabby,  pale  little  granules  are  to  be  lightly  touched 
with  a  stick  of  lunar  caustic  from  time  to  time. 

(3)  The  callous  or  indolent  ulcer. — The  edges  of  this 
ulcer  are  raised,  irregular  and  hard.     The  surrounding  skin 
is  hard,  discolored,  and  brownish-red  and  brawny.     The 
surface  of  the  sore  is  smooth  and  yellowish,  and  there  are 
no  granulations  because  there  is  no  healing  going  on.     Such 
ulcers  are  seen  mostly  on  the  outer  side  of  the  leg,  between 
the  ankle  and  the  calf,  in  persons  of  middle  age.     They  are 
painless,  and  callous,  and  not  tender  to  the  touch. 

Treatment. — First,  of  all,  try  the  pressure  method.  Ap- 
ply a  Martin's  india-rubber  bandage  to  the  ulcer,  without 
any  dressing,  every  morning  before  getting  out  of  bed; 
keep  it  on  all  day,  wearing  it  not  too  tightly.  At  bedtime, 
wash  the  ulcer  with  warm  water  (using  a  piece  of  cotton 
wool  or  rag — never  use  a  sponge  in  surgery!)  and  put  over 
the  ulcer  a  pad  of  lint  soaked  in  rectified  spirit,  and  apply 
an  ordinary  calico  bandage.  The  india-rubber  bandage 
ought  to  be  dipped  or  kept  in  some  disinfectant  during  the 
night. 

If  this  plan  of  treatment  does  not  bring  the  ulcer  into  a 
healthy  condition  a  surgeon  must  be  called,  to  strap  it,  or 
to  incise  it.  There  remains,  however,  one  of  Unna's  meth- 
ods of  treating  these  ulcers;  it  is  this: — Paint  the  ulcer 
itself  and  all  the  surrounding  skin  with  Unna  zinc-ichthyol 
gelatin,  cover  the  whole  with  clean  lint,  bandage  it  and 
leave  it  three  days,  and  then  renew  the  treatment. 

(4)  The  irritable  ulcer. — This  is  commonest  in  elderly 


VARICOSE  ULCER  297 

people  and  is  generally  situated  behind  the  ankle.  The 
surrounding  skin  is  often  purplish,  hard,  and  discolored. 
The  edges  of  the  ulcer  are  raised  and  irregular.  The  sore 
itself  is  dark  red  or  covered  with  a  "slough,"  and  a  thin 
scanty  discharge  issues  from  it.  The  pain  of  it  is  terrible 
and  keeps  the  patient  awake  at  night,  bringing  him  to  a 
severe  condition  of  exhaustion.  The  sore  is  acutely  tender 
to  the  touch.  Absolute  rest  in  bed  is  the  first  essential. 
The  bowels  must  be  moved  occasionally  with  half-a-drop  of 
croton  oil  swallowed  in  a  bread-crumb  pill.  During  the  day, 
if  the  ulcer  is  very  painful,  let  the  sufferer  take  five  grains 
of  antipyrin  and  thirty  grains  of  bicarbonate  of  soda,  four- 
hourly.  At  night,  to  procure  sleep,  some  form  of  opium 
will  probably  be  necessary,  but  it  must  be  prescribed  to  suit 
the  special  case  by  a  doctor. 

The  treatment  of  the  ulcer  itself  is  not  easy.  A  good 
plan  is  to  paint  it  over  with  a  10  per  cent,  solution  of 
cocaine;  ten  minutes  later,  to  rub  it  gently  all  over  with 
lunar  caustic  so  as  to  form  a  slough;  and  then  to  dress  it 
with  boric  acid  ointment  on  lint.  After  a  day  or  two  the 
slough  separates  and  comes  away,  and  a  healthy  sore  ought 
to  remain,  which  is  treated  as  under  (1).  If  the  ulcer  does 
not  look  healthy  yet,  this  plan  may  be  repeated. 

(5)  The  inflamed  ulcer. — This  is  the  sort  of  ulcer  that 
drunkards  are  especially  liable  to  have.     The  surrounding 
skin  is  red,  swollen,  hot  and  tender.     Note,  that  any  ulcer 
may  become  an  "inflamed"  one,  if  neglected.     The  edges 
are  sharply  cut.     The  sore  itself  is  generally  covered  with 
a  slough,  and  there  is  a  blood-stained  discharge  from  it. 
Or  it  may  be  quite  dry  and  covered  with  a  scab. 

Treatment. — The  patient  will  be  all  the  better  for  a  good 
purging,  and  he  may  have  to  be  treated  for  gout.  After 
two  grains  of  calomel  at  bedtime,  the  patient  should  take, 
next  day,  three  times  during  the  day,  a  drachm  of  Epsom 
salts  in  an  ounce  of  infusion  of  quassia.  Very  hot  fomenta- 
tions made  with  boric  lint  and  sprinkled  with  a  few  drops 
of  laudanum,  make  very  good  local  applications  to  the  sore. 
But  the  important  things  in  the  treatment  of  these  ulcers 
are  rest  in  bed,  abstinence  from  alcohol,  and  purging. 

(6)  Varicose    ulcer. — These    are    very    common    among 
middle-aged  and  elderly  women  of  the  poorer  class.     The 
patient  has  varicose  veins,  and  as  a  result  of  them,  the  skin 
of  the  leg,  somewhere  between  the  calf  and  the  ankle,  be- 


298  URINARY  TROUBLES 

comes  badly  nourished,  purplish  in  color,  and  shiny  in  ap- 
pearance. Such  shiny,  discolored  skin  is  very  easily  dam- 
aged by  very  slight  injuries  and  a  sore  is  very  liable  to 
form.  This  sore  as  it  spreads  is  all  too  likely  to  eat  into 
one  of  the  dilated  twisting  varicose  veins ;  and  at  any  time, 
in  a  few  seconds,  the  patient  may  lose  as  much  as  a  pint 
of  blood  (see  " Bleeding  from  Varicose  Veins"). 

Treatment. — No  local  treatment  will  be  of  much  good 
until  the  pressure  of  the  column  of  blood  in  the  dilated 
veins  is  taken  off  the  part  where  the  ulcer  is.  This  must 
be  done  by  wearing  an  elastic  stocking  or  elastic  bandage 
during  the  daytime.  At  night,  hazeline  ointment  may  be 
applied  on  lint  to  the  sore.  But  the  only  radical  treatment 
is  by  operation  on  the  varicose  veins  which  are  causing  the 
trouble. 

Urinary  Troubles. — The  troubles  connected  with  the  pass- 
ing of  water  from  the  body  may  be  described  under  two 
main  headings : — 

A. — Incontinence  of  urine. — Inability  to  hold  water  in 
the  bladder — 

(1)  True  incontinence  is  caused  by  paralysis  of  the 
muscle,  called  the  sphincter,  which  lies  at  the  entrance 
to  the  bladder.     This  paralysis  is  probably  caused  by 
spinal  cord  disease  or  injury  and  may  or  may  not  be 
curable. 

(2)  Incontinence  occurs  in  men  sometimes  as  the 
result  of  sexual  excesses.     Rest  and  tonics  raid  whole- 
some living  will  cure  it. 

(3)  Hysterical  incontinence  occurs  in  young  girls 
sometimes. 

(4)  Nocturnal  or  night  incontinence,  or  bed- wetting, 
occurs  in  children  of  all  ages;  it  may  be  due  to  a  long 
foreskin,  which  requires  circumcision,  or  to  a  stone  in 
the  bladder,  or  to  bad  bringing  up.     (See  No.  7.) 

(5)  False  incontinence  is  the  word  used  to  express 
the  overflow  from  an  over-full  bladder  in  a  paralyzed 
patient. 

(6)  Women  after  childbirth  sometimes  cannot  hold 
their  water  because  of  the  bruising  of  the  parts  during 
the  delivery  of  the  child. 

(7)  Epileptic  attacks  are  often  accompanied  by  the 
dribbling  away  of  urine.     Many  epileptic  children  wet 


DEPOSITS  IN  URINE  299 

the  bed  without  knowing  it,  and  ought  to  be  treated 
for  epilepsy. 

(8)  Fright  sometimes  causes  a  child  to  wet  the  bed. 

B. — Retention  of  urine. — This  means  a  condition  in  which 
the  patient  cannot  pass  his  water  though  the  bladder  is 
quite  full.  It  is  a  very  painful  affection.  It  may  be  due 
either  to  some  obstruction  or  to  paralysis  of  the  bladder — 

(1)  In  old  men  the  obstruction  may  be  an  enlarged 
prostate  gland.     This  is  often  relievable,  but  hardly 
curable. 

(2)  In  adult  men,  the  obstruction  may  be  a  stric- 
ture; congestion,  due  to  gout;  a  little  stone  lodged  in 
the  passage. 

(3)  In  children,  the  foreskin  may  be  too  tight  to 
allow  the  water  to  pass  freely. 

(4)  In  women,  a  tumor  in  the  abdomen,  or  the  head 
of  a  yet  unborn  child  may  press  upon  the  passage  and 
prevent  the  passing  of  the  urine. 

C. — Frequent  desire  to  pass  water. — This  may  occur  in 
one  of  two  different  sets  of  circumstances.  Some  people 
are  always  wanting  to  urinate  because  their  bladder  seems 
to  be  always  full,  and  in  fact,  does  fill  up  very  quickly. 
This  occurs  with — 

(1)  Diabetes. 

(2)  Chronic  B  right's  disease. 

(3)  Hysteria  in  women. 

(4)  Chronic  drunkards. 

Other  people  are  continually  wanting  to  pass  water  be- 
cause the  bladder  is  so  irritable  that  it  will  not  tolerate  the 
presence  of  even  a  few  drops  of  water  in  it.  This  occurs 
in — 

(1)  Inflammation  of  the  bladder. 

(2)  Inflamed  prostate  gland. 

(3)  Enlarged  prostate  gland  (in  old  men  chiefly). 

(4)  A  stone  in  kidney  or  bladder. 

D. — Deposits  in  urine. — The  man  who  worries  himself 
about  his  health  so  much  as  to  look  at  his  tongue  in  the 


300  VACCINATION 

glass  every  morning,  and  to  examine  the  color  of  his  urine, 
often  frightens  himself  quite  unnecessarily.  The  deposits 
which  may  be  seen  in  the  urine  are  very  numerous,  and 
most  of  them  indicate  something  seriously  wrong  with  the 
individual.  But  there  are  other  deposits  which  are  less 
important,  or  unimportant  and  far  more  common.  Quite 
normal,  healthy  urine  is  clear  and  amber-colored  when 
passed.  But  urine  may  be  turbid  when  passed,  and  that 
turbidity  is  generally  caused  by  eating  too  much  meat,  or 
by  a  little  catarrh  of  the  bladder  caused  by  catching  cold. 
After  a  heavy  meal  there  is  sometimes  a  brick-dust  sort  of 
deposit,  reddish-yellow,  pink,  or  red.  It  is  of  no  impor- 
tance, but  suggests  that  you  have  been  eating  too  much 
meat,  or  that  you  have  a  bad  cold,  or  that  you  are  feverish. 

In  short,  a  little  knowledge  of  the  urine  is  really  a  dan- 
gerous thing  to  all  who  are  unduly  nervous.  The  only  good 
reason  for  examining  the  urine  passed  is  to  enable  you  to 
report  it  truly  to  the  doctor,  and  not  to  enable  you  to 
doctor  yourself  without  understanding  the  subject. 

Vaccination. — We  of  to-day  little  realize  how  enormous 
the  destruction  of  life  from  smallpox  was  up  to  a  hundred 
years  ago  when  control  was  obtained  over  it  by  means  of 
the  process  known  as  vaccination. 

During  the  18th  century  60,000,000  of  the  inhabitants 
of  Europe  died  from  smallpox  and  there  were  few  who 
escaped  having  the  disease  some  time  during  their  life. 

Since  the  introduction  of  vaccination  the  reduction  of  the 
amount  of  smallpox  has  been  so  great  that  there  can  be  no 
doubt  of  its  infinite  value. 

The  death  rate  in  Sweden  per  million  has  been  reduced 
from  2,050  before  the  vaccination  era  to  2  in  1894.  In 
1897  there  were  only  5  deaths  from  smallpox  in  the  entire 
German  Empire  of  54,000,000  people.  In  Russia,  where 
vaccination  is  neglected,  there  are  still  over  50,000  cases  a 
year. 

If  a  person  is  vaccinated  in  infancy  and  again  at  the 
end  of  childhood  he  is  practically  safe  from  smallpox.  He 
is  absolutely  safe  if  he  is  revaccinated  every  ten  years. 

There  is  no  danger  from  vaccination.  The  vaccine  is 
now  manufactured  in  an  absolutely  pure  condition  and 
there  is  no  possibility  of  contracting  any  disease  through 
vaccination.  The  reaction  is  slight  and  never  lasts  more 
than  a  day  or  two. 


VARJCOCELE  301 

Every  child  should  be  compelled  to  be  vaccinated  before 
one  year  of  age  and  again  when  a  pupil  of  a  private  or 
public  school  at  9  or  10  years  of  age. 

We  should  not  be  lulled  into  a  sense  of  false  security  by 
the  practical  absence  of  smallpox  in  this  country  at  the 
present  time.  If  we  should  relax  our  precautions  and  dis- 
continue vaccination  smallpox  would  soon  become  almost 
as  common  now  as  it  was  100  years  ago. 

The  disfigurement  of  the  face  from  smallpox  known  as 
pock  marking  or  pitting  is  permanent.  Without  vaccina- 
tion you  can  never  feel  that  you  are  free  from  this  danger. 

Vaccination  is  a  very  simple  procedure;  but  should  be 
done  by  a  physician. 

Varicella. — This  is  the  medical  name  of  chickenpox 
(which  see).  Chickenpox  and  smallpox  (variola)  are 
quite  distinct  diseases,  because  chickenpox  occurs  in  chil- 
dren whether  vaccinated  or  not,  and  an  attack  of  it  does 
not  protect  from  smallpox. 

Varicocele. — A  varicocele  is  a  little  bunch  of  dilated  and 
knotted  veins  in  the  "purse"  or  scrotum  of  a  man.  It  is 
the  result  and  not  the  cause  of  that  ' '  loss  of  manly  vigor, ' ' 
that  "diminished  sexual  power,"  and  that  "debility," 
which  figure  so  largely  in  the  advertisements  relating  to  the 
cure  of  varicocele.  We  beg  to  remind  our  readers  that  no 
registered  doctor,  surgeon,  or  physician  in  America  is  al- 
lowed to  advertise,  and  that  if  he  does  so,  he  runs  a  risk 
of  losing  his  position  as  a  member  of  the  honorable  faculty 
of  medicine. 

The  youth,  then,  who,  as  the  result  of  fast  living  or  bad 
habits,  begins  to  wonder  why  he  is  weak  and  wretched  is 
only  too  apt  to  believe  advertisements  when  they  tell  him 
that  varicocele  is  at  the  root  of  all  his  trouble,  and  that 
the  cure  or  removal  of  the  varicocele  will  restore  all  his 
power.  That  is  not  true.  Restoration  of  virility  and  man- 
liness will  take  place  at  once  (though  slowly),  on  the  re- 
sumption of  a  clean  mode  of  life — early  hours,  hard  work, 
and  not  too  much  food.  The  varicocele  may  or  may  not  be 
cured.  It  is  not  half  as  dangerous,  even  when  it  is  large, 
as  a  varicose  vein  of  the  leg,  which  may  ulcerate  and  bleed 
you  to  death ! 

We  now  come  to  the  surgery  of  this  subject. 

A  varicocele  is  a  little  bunch  of  twisted  and  knotted  veins 
inside  the  scrotum,  or  fleshy  bag  which  contains  the  testi- 


302  VARICOCELE 

cles.  The  swelling  may  be  very  small,  or  so  large  as  to  be 
a  nuisance.  It  is  greater  when  the  man  stands  up,  and 
gets  smaller  when  he  lies  down.  It  increases  for  a  time 
after  coughing  or  exertion.  Sometimes  it  may  be  compli- 
cated by  a  " rupture"  or  hernia,  and  for  that  reason  no 
young  man  ought  to  bother  himself  about  his  varicocele  or 
buy  bandages  for  its  treatment  until  he  has  consulted  a 
surgeon,  who  will  tell  him  exactly  what  is  wrong.  If  only 
young  men  would  go  to  respectable  family  doctors  and  ask 
about  all  private  natural  matters  which  they  don't  under- 
stand, how  much  heart-burning  might  be  saved!  Some- 
times a  varicocele  is  attended  with  a  sensation  of  weight  and 
aching,  especially  if  it  is  large  and  unsupported  by  a  ban- 
dage. Sometimes  the  neuralgic  pain  of  it  is  very  great. 
Occasionally,  but  rarely,  a  vein  " bursts,"  and  the  scrotum 
fills  up  with  blood. 

Treatment. — There  are  two  ways  of  treating  a  varicocele, 
if,  indeed,  it  is  large  enough  to  cause  any  annoyance.  One 
is  the  palliative  treatment.  This  consists  in  attending  to 
the  general  health  by  tonics  and  exercise  and  by  living  a 
cleaner  and  more  moral  life,  and  by  wearing  a  suspensory 
bandage  which  supports  the  varicocele  and  soon  relieves 
the  pains,  and  by  bathing  the  parts  with  cold  water  night 
and  morning.  The  other  way  of  treating  a  varicocele 
is  the  radical  method.  This  consists  of  a  little  surgical 
operation  for  the  tying,  or  tying  and  removal  of  the  whole 
bunch  of  enlarged  veins.  The  little  operation  is  free  from 
danger  and  is  done  quite  painlessly.  The  testicle  is  not 
touched  or  in  any  way  damaged,  and  it  does  not  waste 
away  afterwards,  except  in  a  few  cases  when  it  was  already 
wasting  from  a  poor  blood  supply.  But  even  if  the  testicle 
of  the  left  side  (and  varicocele  is  nearly  always  on  the  left 
side)  does  waste  away,  there  is  still  one  left;  and  a  man  is 
just  as  well  able  to  procreate  children  with  one  as  with 
two.  These  remarks  will  be  appreciated  by  all  those  who 
are  continually  sending  letters  to  the  medical  editors  of 
papers  asking  for  information  on  these  subjects. 

The  circumstances  for  which  radical  cure  of  a  varicocele 
is  generally  undertaken  are  these : — 

1.  When  the  existence  of  a  varicocele  disqualifies  a  man 
for  admission  to  the  public  services. 

2.  Great  discomfort  and  neuralgic  pain  from  a  very  large 
varieocele. 


VARICOSE  VEINS  303 

3.  Those  cases  of  young,  well-educated  and  sedentary 
men,  who  worry  about  themselves,  fidget  about  the  local 
condition  which  they  can  see  and  feel  for  themselves,  and 
suffer  from  amorous  dreams  and  uncomfortable  sensa- 
tions. 

Varicose  Ulcer. — Many  people  have  varicose  veins  of  the 
legs,  especially  women  who  have  borne  many  children. 
Sometimes  a  vein,  if  unsupported  by  an  elastic  stocking, 
gives  way  and  bleeds.  When  the  bleeding  has  been  stopped, 
a  little  sore  remains  which  is  all  too  apt  to  become  a  regular 
chronic  ulcer  of  the  leg.  Rest  in  bed  is  the  first  essential. 
(See  "Ulcers.") 

Varicose  Veins. — This  name  is  applied  to  a  dilated  and 
tortuous  condition  of  the  veins,  most  common  in  the  legs, 
and  usually  due  to  long  standing,  severe  muscular  exertion, 
pressure  from  a  tumor  or  some  intra-abdominal  condition, 
or  an  organic  affection  of  the  heart.  Hereditary  disease 
such  as  gout  may  predispose  to  this  condition  by  a  weaken- 
ing of  the  walls  of  the  veins. 

The  appearance  of  the  tortuous  vein  meandering  up  the 
leg  cannot  be  mistaken. 

It  is  usually  accompanied  by  a  feeling  of  fatigue  and  a 
sense  of  fullness  of  the  limb  after  exercise  or  long  standing. 

The  circulation  may  become  so  poor  that  the  tissues  be- 
come poorly  nourished,  congested,  inflamed  (varicose  ec- 
zema), or  may  die,  producing  a  varicose  ulcer.  These  com- 
plications are  usually  intractable  and  require  the  help  of 
a  physician  to  heal. 

The  palliative  treatment  of  a  varicose  vein  consists  in 
supporting  it  by  an  elastic  stocking  and  reducing  the  hours 
of  standing. 

The  radical  treatment  consists  in  the  excision  of  a  greater 
or  less  portion  of  the  dilated  vein  with  ligation — to  force 
the  blood  back  through  the  deeper  veins  of  the  leg.  The 
radical  method  is  recommended  in  aggravated  cases  or 
cases  with  intractable  ulcers  or  eczema. 

Vegetarianism. — Real  vegetarian  diet  consists  only  of 
fruits,  nuts  and  vegetable  produce  of  every  kind.  There 
are  few  real  vegetarians  because  they  very  soon  discover 
that  to  take  enough  vegetarian  diet  to  work  upon,  they  need 
absurdly  large  quantities  of  it.  Moreover,  vegetables  all 
contain  a  very  high  percentage  of  water  in  their  composi- 
tion, and  sooner  or  later  the  bowels  get  out  of  order. 


304  VEGETARIANISM 

A  rational  and  altogether  satisfactory  diet  (from  the 
health  point  of  view)  is  the  modified  vegetarian  diet — that 
is,  one  which  admits  eggs,  milk  and  cheese  in  moderation. 
This  fleshless  diet  is,  of  course,  not  a  purely  vegetarian  one ; 
for  eggs  and  milk  are  highly  concentrated  animal  foods. 
But  there  is  no  doubt  that  thousands  of  us  would  be  all  the 
better  if  we  ate  no  flesh.  The  man  who  eats  no  meat  or 
very  little  meat,  soon  gets  to  care  very  little  for  alcoholic 
drinks,  and  soon  finds  that  his  pocket  benefits,  and  that  his 
health  is  better.  It  is  the  " fumes"  of  a  flesh  diet  which 
give  rise  to  thirst;  and  the  large  amount  of  waste  matter 
in  flesh  food  and  the  difficulty  of  getting  rid  of  it  by  the 
kidneys  are  the  causes  of  the  craving  for  stimulants.  It  is 
not  to  be  expected  that  people  will  give  up  their  joints  of 
roast  beef ;  and  perhaps  the  nation  would  lose  much  of  its 
fighting  propensity  if  they  did.  But,  nevertheless,  the 
middle-aged  man  who  wants  to  feel  young  still,  who  wants 
to  avoid  rheumatic  pains  and  gouty  attacks,  and  who 
doesn't  want  to  be  a  soldier,  or  to  take  part  in  any  amuse- 
ments which  depend  upon  brute  strength  and  animal 
powers,  may  do  much  worse  than  restrict  his  animal  diet, 
or  do  without  flesh  altogether.  The  acid  properties  of  a 
half-pound  of  fillet  of  beef,  washed  down  with  a  pint  of 
beer,  make  a  man  feel  at  peace  with  the  world  and  send 
him  (where  possible)  to  the  armchair  for  a  smoke  and  an- 
other glass  of  stimulant.  But  if  he  is  middle-aged,  and 
especially  if  he  has  no  manual  labor  to  do,  he  has  eaten  a 
meal  far  in  excess  of  his  requirements,  and  of  a  nature  dif- 
ferent from  that  which  he  needs  for  brain  work.  It  is 
lucky  for  him  if  years  of  this  kind  of  ''solid  feeding"  don't 
provide  a  future  for  him  of  gout,  rheumatism  or  apoplexy ! 
This  doctrine  is  not  as  "cranky"  as  some  may  suppose. 
We  do  not  find  fault  with  the  hearty  meals  of  the  youth 
who  has  to  work  and  play  hard.  But  we  strenuously  main- 
tain that  brain-workers  and  business  men  would  drink  less, 
work  harder,  and  be  more  clear-headed  on  a  fleshless  diet 
than  on  either  a  full-flesh  or  a  vegetarian  diet.  The  experi- 
ment, in  any  case,  would  not  only  cost  a  man  nothing,  but 
would  save  money  for  him,  for  meat  is  an  expensive  item; 
and  the  experimenter  would  find  himself  fresh  and  brisk 
in  the  mornings,  indifferent  to  continual  and  stupid 
'  *  liquoring-up, ' '  and  free  from  most  of  the  aches  and  pains 
that  we  call  rheumatic.  Age,  sex  and  occupation,  of  course, 


VENEREAL  DISEASES  305 

produce  great  variations  in  our  food  requirements.  Per- 
sons much  exposed  to  the  weather  require  fats  and  sugars 
and  starches.  Children  require  much  meat,  or,  rather, 
milk,  eggs  and  cheese ;  whereas  old  people,  if  they  want  to 
live  long,  will  have  to  eat  sparingly,  especially  of  animal 
foods.  In  conclusion,  we  recommend  to  the  notice  of  all 
our  middle-aged  and  elderly  readers  the  wise  little  book  of 
Sir  Henry  Thompson,  entitled  Diet  in  Relation  to  Age  and 
Activity,  which  can  be  ordered  through  any  bookseller.  It 
is  not  a  work  on  vegetarianism,  however. 

Venereal  Diseases. —  (See  also  "Syphilis"  and  "Gonor- 
rhea.")— Until  very  recently  it  has  not  been  realized  what 
a  vast  amount  of  venereal  disease  there  is  in  this  country. 
One  reason  has  been  because  these  diseases,  syphilis  and 
gonorrhea,  rarely  appear  in  our  mortality  statistics  and 
because  we  have  never  taken  the  trouble  to  tabulate  the 
simple  cases.  But  many  of  these  cases  produce  more  seri- 
ous conditions  and  it  is  by  determining  the  results  of  these 
diseases  that  we  know  how  abundant  they  must  be  and  what 
enormous  damage  they  are  doing. 

Syphilis  is  a  cause  of  a  large  part  of  the  following  fatal 
diseases: — General  paralysis,  locomotor  ataxia,  paraplegia, 
softening  of  the  brain,  arteriosclerosis,  aneurism  and  still 
births. 

Gonorrhea  is  responsible  for  80  per  cent,  of  the  deaths 
due  to  inflammatory  diseases  peculiar  to  women.  It  is  the 
cause  of  many  of  the  cases  of  rheumatism  and  most  of  the 
cases  of  blindness  in  infancy. 

These  diseases  are  sometimes  contracted  innocently — as, 
e.  g.,  an  innocent  wife  from  a  "fast"  husband;  but  most 
of  them  come  as  the  direct  result  of  immorality. 

It  is  doubtful  whether  laws  will  ever  aid  much  in  con- 
trolling this  evil. 

It  is  certain,  however,  that  moral  teaching  can  do  much 
— especially  when  backed  up  by  the  facts  of  what  suffer- 
ing, sorrow,  and  disease  may  result  from  a  departure  from 
moral  methods  of  living.  It  is  a  question  how  old  children 
should  be  before  they  are  educated  on  the  "social  evil"; 
but  such  education  should  certainly  be  given  before  a  child 
is  sent  off  to  school  or  college,  or  freed  from  home  re- 
straints. 

If  syphilis  or  gonorrhea  should  ever  be  contracted  by  any- 
one they  should  place  themselves  at  the  earliest  possible 


306  VENTILATION 

moment  under  the  care  of  a  physician  and  absolutely  avoid 
all  possibility  of  transmitting  the  disease  until  they  have 
been  pronounced  cured  and  free  from  infection. 

Ventilation. — The  idea  of  human  beings  living  steeped  in 
their  own  excretions  is  not  a  pleasant  one  to  dwell  upon; 
yet  this  is  just  what  countless  people  in  shops  and  houses 
are  doing  when  they  breathe  air  not  sufficiently  renewed 
by  ventilation. 

When  we  realize  that  there  are  many  buildings  in  New 
York  City  where  several  thousand  people  spend  their  days 
on  a  ground  area  of  100  x  100  feet;  that  the  streets  be- 
tween are  narrow  and  dark  and  the  spaces  between  are 
cistern-like  and  filled  with  stagnant,  lifeless  air  we  can 
understand  the  headache,  depression,  anaemia  and  impaired 
health  which  many  of  the  " sky-scraper"  denizens  feel. 

Of  the  importance  of  ventilation  we  as  a  nation  are  as 
yet  almost  totally  ignorant.  We  appreciate  how  much  bet- 
ter we  all  feel  out-of-doors,  but  we  don't  seem  to  realize 
that  the  reason  we  feel  less  well  in-doors  is  because  we 
breathe  air  which  is  shut  up  in  rooms  inadequately  circu- 
lated and  inadequately  renewed. 

Ventilation  is  required  to  rid  the  air  of  its  gaseous  im- 
purities and  the  watery  vapor  which  result  from  the  respi- 
ration and  transpiration  of  human  beings,  and  to  reduce 
these  to  such  an  extent  that  the  air  of  inhabited  rooms  shall 
not  be  detrimental  to  health.  Solids,  as  dust,  microorgan- 
isms, etc.,  are  not  removed  by  the  ordinary  means  used  for 
ventilation,  and  the  circulation  of  fresh  air  through  an 
apartment  cannot,  therefore,  take  the  place  of  methods  of 
cleaning. 

The  amount  of  fresh  air  required  for  each  person  per 
hour  is  3,000  cubic  feet.  As  air  cannot  be  changed  com- 
fortably, without  producing  some  feeling  of  draught,  more 
than  three  times  an  hour,  each  person  in  a  house  should 
have  at  least  1,000  cubic  feet  of  air  space.  The  legal  mini- 
mum for  shops  and  factories  in  most  states  is  250  cubic 
feet  by  day  and  400  cubic  feet  by  night.  Each  gas  burner 
consumes  4  cubic  feet  of  gas  per  hour  and  requires  4,800 
cubic  feet  of  fresh  air  an  hour.  This  must  be  added  to  the 
air  required  by  people  in  a  room.  Electric  lights  do  not 
consume  any  air. 

The  ideal  scheme  of  ventilation  is  one  in  which  the  air 
is  derived  from  a  pure  source  some  feet  above  the  ground, 


VENTILATION  307 

washed  and  filtered  free  of  dust  and  impurities,  given  a 
proper  degree  of  humidity  and  temperature,  forced  into 
each  individual  room,  sucked  out  through  a  pipe  and  ex- 
pelled out  of  doors. 

This  is  known  as  the  artificial  method  of  ventilation. 
The  natural  method  depends  upon  diffusion,  wind,  and  tem- 
perature to  cause  a  circulation  of  air  and  is  largely  a  mat- 
ter of  luck.  Wind  and  temperature  cause  warmed  air  to 
go  up  the  chimney  and  it  is  hoped  that  fresh  air  to  replace 
this  will  get  in  somehow. 

Diffusion  stirs  up  the  air  and  dilutes  the  impure  air  with 
air  not  yet  used. 

The  advantages  of  the  artificial  over  the  natural  methods 
are  its  constancy  under  all  conditions  and  the  facilities 
which  it  affords  for  regulating  the  source  and  amount  of 
fresh  air,  and  the  preparatory  treatment  as  to  temperature, 
moisture  and  purification. 

In  any  scheme  of  ventilation  regard  must  be  had  to  the 
following  practical  points : — 

1.  When  air  is  heated  it  expands  and  tends  to  rise;  when 
air  is  cooled  it  contracts  and  tends  to  fall. 

2.  The  inlet  provision  for  fresh  air  should  average  24 
square  inches  for  each  individual;  the  provision  of  inlet 
areas  somewhat  larger  than  those  of  exit  tends  to  immunize 
draughts. 

3.  Inlets  should  be  low  in  the  room  and  incoming  air 
should  be  directed  upwards  if  cold  and  downwards  if  warm. 

4.  There  is  a  tendency  for  fresh  air  to  take  a  direct 
course  to  the  outlets,  and  this  must  be  counterbalanced  by 
a  judicious  selection  of  the  relative  positions  of  inlets  and 
outlets. 

5.  With  less  than  250  cubic  feet  of  space  per  head,  no 
ventilation  can  be  satisfactory  which  is  not  aided  by  me- 
chanical force. 

6.  The  source  of  the  incoming  air  should  be  considered. 
It  should  not  be  borrowed  from  adjoining  rooms,  but  taken 
direct  from  the  outside. 

7.  If  warmed  air  is  forced  into  a  room,  it  should  only 
be  raised  to  a  temperature  sufficient  to  prevent  a  feeling  of 
cold  (about  60°  F.).     More  highly  heated  air  is  often  felt 
to  be  overdry  and  unpleasant. 

8.  Mechanical   methods  of  ventilation   are  essential  in 
all  office  and  public  buildings,  factories  and  theaters.     It 


308  WAETS 

is  advisable  in  all  apartment  houses  and  homes  unless  the 
expense  of  installation  and  maintenance  is  prohibitory. 

Warts. — Everybody  knows  what  a  wart  is,  but  everybody 
does  not  know  that  a  wart  is  something  between  a  mere 
thickening  of  the  skin  and  a  cancerous  tumor.  A  cancer 
growing  from  the  skin  (called  an  epithelioma)  is  practically 
a  wart  of  a  certain  type — a  wart  which,  if  left  alone,  will 
at  last  ulcerate,  cause  swollen  cancerous  glands  in  the  arm- 
pit and  perhaps,  also,  cancerous  growths  in  internal  organs 
such  as  the  womb  or  liver.  Of  course,  most  warts  are,  and 
probably  will  always  remain  harmless;  but  as  no  one  can 
tell  exactly  whether  a  wart  is  going  to  become  cancerous  or 
not,  it  is  always  worth  while  to  get  it  removed. 

Children's  warts  are  found  chiefly  on  the  fingers  or 
knuckles,  and  are  tough,  flat,  circular  knobs  of  hardened 
skin,  ingrained  with  brownish  dirt,  and  apt  to  bleed  if  the 
topmost  layer  of  skin  is  knocked  off.  They  may  come  in 
crops  whenever  the  child  is  a  little  out  of  health.  They  can 
be  destroyed  by  caustics  such  as  ethylate  of  soda,  lunar 
caustic,  nitric  acid  pure,  or  caustic  potash.  A  little  of  the 
caustic  is  applied  daily,  from  the  end  of  a  wooden  match, 
care  being  taken  to  touch  only  the  wart  and  not  the  skin 
surrounding,  and  to  let  it  dry  on.  Little  by  little  the  tough 
hard  skin  shreds  off  and  the  wart  is  gone.  A  little  lime 
water  taken  after  food  daily  is  said  to  assist  in  causing 
warts  to  disappear.  Sea  water  has  also  been  used. 

Pigmented  warts. — Colored  warts  are  the  ones  which 
should  certainly  be  removed,  for  they  are  always  apt  to 
grow  into  malignant  tumors  as  the  person  gets  on  in  years. 

Tuberculous  warts  are  common  on  the  hands  of  students, 
post-mortem  room  porters  and  funeral  officials.  They  must 
be  cut  out  by  a  surgeon. 

Cancer  developing  from  a  wart  is  of  very  rare  occurrence 
before  middle  age.  About  that  time  (say  45)  and  after, 
the  continual  smoking  of  a  hot-stemmed  clay  pipe  is  apt 
to  cause  cancer  of  the  lip.  Chimney  sweeps  are  liable  to 
cancerous  warts  of  the  skin  on  the  scrotum,  caused  by  the 
irritation  of  soot,  and  by  lack  of  cleanliness.  The  continual 
drinking  of  bad  spirits  certainly  makes  a  man  more  liable 
to  cancer  of  the  stomach. 

Note. — Neither  warts  nor  cancers  are  easily  caught  by  one 
person  from  another.  But  there  is  something  in  the  idea 
that  the  blood  of  a  wart  will  sometimes  produce  another 


WATER  309 

wart  if  rubbed  on  healthy  skin.  And  as  to  cancers,  it  is 
undeniable  that  there  are  houses  in  which  person  after 
person,  for  generations,  gets  the  disease  from  merely  living 
in  them.  Such  are  called  "cancer  houses,"  and  ought  to 
be  avoided.  It  has  also  been  noticed  that  the  husband  of 
a  wife  with  cancer  of  the  womb,  or  the  breasts,  frequently 
develops  cancer  himself  later  on. 

Water, — There  is  no  greater  necessity  of  life  than  an 
ample  supply  of  pure  water,  especially  for  drinking  pur- 
poses. But  the  amount  we  drink  is  very  small  compared 
to  the  amount  which  must  be  provided  per  head  for  the 
inhabitants  of  a  town.  Allowance  has  to  be  made  for  ordi- 
nary washing  and  personal  cleanliness,  for  the  baths  and 
domestic  washing,  for  closets  and  for  cooking,  and  for  street 
cleansing  and  for  use  in  gardens. 

In  some  towns  sea  water  is  used  in  the  streets  and  for 
the  sewers,  and  in  many  places  rain  water  is  used  for  wash- 
ing. In  solitary  cottages  and  small  villages  water  is  gen- 
erally obtained  from  shallow  wells,  and  this  supply  may 
be  pure  enough  for  use  when  the  population  is  small  and 
scattered.  Shallow  wells  are,  however,  very  liable  to  pollu- 
tion from  surface  drainage,  and  from  this  reason  the  water 
may  be  seriously  contaminated.  As  villages  grow  into 
towns  a  supply  of  drinking  water  has  to  be  fetched  from 
hills  at  a  distance,  and  conveyed  through  canals  or  under- 
ground pipes.  In  some  districts  it  is  found  possible  to 
obtain  a  supply  of  water  by  boring  very  deeply  with  iron 
pipes  in  short  lengths  until  a  water-bearing  stratum  is 
reached;  these  are  called  artesian  wells.  Such  water  is 
generally  very  pure,  but  may  be  too  hard.  A  water  is  said 
to  be  hard  when  it  has  dissolved  in  it  too  much  lime  ab- 
sorbed from  the  soil.  Sea  water  is  useless  for  drinking  or 
for  domestic  use,  being  too  salt. 

Rain  water,  although  very  pure,  if  collected  away  among 
mountains  or  very  far  from  dwellings,  is  both  dirty  and 
impure  when  collected  in  towns.  The  air  of  towns  is  con- 
taminated with  carbonic  acid  and  sulphur,  dust  of  a  thou- 
sand sorts,  emanations  from  the  skin  and  germs  of  infection, 
and  rain  in  falling  through  it  becomes  dirty,  impure,  and 
unfit  to  drink. 

All  towns  now  have  a  public  water  supply.  This  may  be 
of  two  sorts — one  in  which  the  pipes  supplying  each  street 
and  house  are  kept  constantly  full  of  water,  under  full 


310  WATER 

pressure,  at  all  hours;  and  on  the  other  mode  of  supply 
each  house  has  to  have  a  tank  for  storing  water,  because 
the  supply  under  pressure  is  only  turned  on  for  an  hour 
or  two  each  day.  This  latter  plan  is  more  common  than 
the  first,  which  is  better.  Under  the  constant  supply  more 
water  runs  to  waste,  but  with  the  occasional  system  there 
is  always  a  risk  to  health  from  cisterns  which  may  be  kept 
in  a  dirty  state  or  may  get  rubbish  thrown  into  them. 

Unless  a  person  has  seen  a  drop  of  dirty  water  exhibited 
under  a  microscope,  it  is  difficult  to  believe  what  a  collec- 
tion of  very  minute  living  beings  may  be  contained  in  it. 
Many  of  these  are,  no  doubt,  harmless,  but,  on  the  other 
hand,  many  are  germs  of  different  diseases.  These  micro- 
scopic germs,  bacteria,  and  bacilli  multiply  with  amazing 
rapidity,  especially  in  water  which  lies  stagnant. 

They  get  into  the  water  from  the  rain,  or  from  the  soil 
through  which  the  water  has  run,  and  may  fall  into  the 
water  in  our  cisterns  if  not  well  covered.  Many  diseases 
are  known  to  be  spread  by  water  containing  the  special 
germs  of  the  disease,  and  this  is  especially  the  case  with 
typhoid  fever.  Slops  may  be  thrown  away  in  gardens,  or 
sewage  from  infected  houses  may  soak  through  the  ground 
and  find  its  way  into  the  water  of  shallow  wells,  and  so 
one  case  may  lead  to  the  occurrence  of  many  other  cases. 
In  this  way  typhoid  fever  is  always  common  among  soldiers 
in  camps,  especially  during  war  time,  when  it  is  so  difficult 
to  secure  sanitary  conditions.  In  a  war  typhoid  fever  al- 
ways kills  more  men  than  the  guns  of  the  enemy.  Drinking 
water  kept  in  tanks  may  be  wholesome  enough  if  great 
care  is  taken  to  keep  tanks  clean  and  covered,  and  if  a  full 
supply  is  added  daily,  while  a  certain  amount  is  drawn 
away  every  day  for  use.  But  in  poor  districts  it  is  always 
found  to  be  very  difficult  for  landlords  to  keep  the  cisterns 
clean.  Of  course,  many  landlords  are  very  careless,  and 
pay  but  little  attention  to  the  needs  of  poor  tenants;  and 
when  a  landlord  does  his  best,  poor  tenants  are  apt  to  be 
grossly  careless  and  dirty  in  their  habits.  They  leave  cov- 
ers off,  or  let  children  play  in  the  tanks,  and  but  rarely 
watch  that  the  water  in  them  is  clean.  Cisterns  are  often 
badly  situated  in  dwelling  houses;  they  should  be  as  far 
as  possible  from  the  closets,  and  should  be  placed  so  as  to 
be  frequently  inspected;  they  should  be  scrubbed  out  at 
least  every  three  months.  Pure,  wholesome  water  should 


WATER  PURIFICATION  311 

be  clear,  sparkling,  and  colorless,  without  the  faintest  smell 
or  taste,  and  should  not  be  too  hard  with  dissolved  lime. 
Impure  water  sets  up  diarrheal  colic,  sore  throat,  nausea, 
and  loss  of  appetite.  Life  is  never  safe  without  a  pure 
water  supply. 

Water  Purification. — So  many  of  the  infectious  diseases 
may  be  contracted  through  a  polluted  water  supply  that  it 
is  advisable  as  a  routine  measure  to  avoid  all  chance  of 
contracting  disease  in  this  way  by  drinking  only  water 
which  has  been  purified. 

Some  city  water  supplies  are  filtered  before  being  dis- 
tributed. 

Others  are  not.  Whether  the  city  water  is  filtered  or  not, 
home  measures  for  purification  are  advisable. 

The  chief  measures  for  purification  are — boiling,  filtra- 
tion, distillation  and  chemical  treatment. 

Boiling  destroys  bacteria  and  removes  temporary  hard- 
ness. This  is  one  of  the  safest  ways  of  purifying  water, 
but  it  may  taste  flat  unless  the  air  which  has  been  removed 
by  boiling  is  replaced  by  aeration. 

Distillation  is  the  most  universally  applicable  mode  of 
purification,  and  even  sea  water  can  be  utilized  in  this  way. 

The  process  of  distillation  is  a  slow  one,  however,  and  the 
water  may  taste  flat  from  want  of  natural  salts  and  air. 

Filtration  is  a  very  good  method  of  home  water  purifi- 
cation provided  good  filters  are  used  and  kept  in  good  order. 

The  best  filters  are  the  Berkefeld  and  the  Pasteur-Cham- 
berland,  which  can  be  applied  to  the  water  tap. 

Every  few  days  the  filter-candle  should  be  removed  from 
these  filters,  and  thoroughly  scrubbed  and  boiled  before 
being  replaced. 

Chemical  processes  are  used,  for  the  most  part,  in  the 
removal  of  inorganic  impurities — especially  lime.  This  is 
best  done  in  connection  with  filtration,  and  many  large 
filters  are  provided  with  an  arrangement  by  which  the  lime 
is  precipitated  out  of  the  water  as  it  passes  through  the 
filter  by  means  of  alum. 

The  purest  water  supplies  are  those  which  come  origi- 
nally from  mountain  springs,  deep-driven  wells  and  prop- 
erly-filtered city  water. 

Water  Brash  is  a  clear  alkaline  fluid,  much  like  saliva  (or 
spittle)  in  appearance,  which  comes  into  the  mouth  in 
gushes,  and  has  to  be  spat  out,  generally  in  the  early  morn- 


312  WHITE  LEG 

ing.  Sometimes  it  comes  up  without  any  trouble,  some- 
times it  is  vomited  up  with  painful  retching.  It  is  actually 
spittle,  from  the  mouth,  which  has  been  swallowed  during 
the  night  and  comes  up  again  in  the  morning.  It  is  a  sign 
of  chronic  inflammation  of  the  stomach,  and  is  probably 
caused  by  over-indulgence  in  alcoholic  liquors.  (See  also 
"Indigestion.") 

Watercress  AND  ITS  DANGERS. — If  watercress  is  grown  in 
a  stream  of  clear  water  it  is  a  most  valuable  salad,  and  is 
well  suited  for  eating  with  bread  and  butter  at  meals  when 
tea  is  drunk.  It  is  very  purifying  to  the  blood,  containing 
potash  with  vegetable  acids.  There  is,  however,  a  risk  of 
being  infected  with  typhoid  fever,  and,  perhaps,  also,  of 
swallowing  the  eggs  of  worms  which  may  breed  in  the 
bowels,  if  the  water  is  foul,  stagnant  or  has  become  soiled 
with  sewage  materials  draining  from  the  fields  or  gutters. 
All  watercress  should  be  pulled  to  pieces  and  thoroughly 
washed  by  water  running  from  a  tap,  or  with  several  lots 
of  water  in  a  bowl. 

Water-on-the-Brain. — This  is  the  popular  name  for  menin- 
gitis, or  inflammation  of  the  membranes  of  the  brain,  called 
in  novels,  "brain-fever."  It  is  generally  due  to  tubercu- 
lous disease.  Children  are  sometimes  born  with  water-on- 
the-brain,  which  has  swelled  up  their  heads,  and  which 
crushes  their  brains  and  makes  them  more  or  less  idiotic. 

Weir-Mitchell  Treatment. — This  is  an  expensive  treatment 
for  neurasthenia  (which  see).  It  consists  of  complete  rest 
in  bed,  without  letters  or  newspapers,  or  worrying  visitors ; 
overfeeding  and  massage  to  take  the  place  of  muscular 
exercise.  The  patient  is  allowed  to  see  no  one  except  the 
doctor  and  the  nurse.  It  is  a  splendid  treatment  for  ex- 
haustion and  brain-fag. 

Wens. — A  wen  is  a  cyst  of  the  skin  caused  by  blockage 
of  the  mouth  of  a  little  gland;  it  is  full  of  a  cheesy  sub- 
stance called  sebum,  and  occurs  commonly  on  the  scalp  or 
neck.  Doctors  call  wens  sebaceous  cysts.  They  are  round, 
dome-like,  semi-fluid  tumors,  but  quite  harmless.  They  may 
be  easily  removed  under  cocaine  without  pain,  by  any  sur- 
geon. 

White  Leg. — A  swelling  of  the  whole  of  one  leg,  occur- 
ring, sometimes,  in  women  after  childbirth,  also  in  con- 
valescence from  pneumonia  or  typhoid  fever. 

Symptoms. — For  a  few  days,  pain  and  tenderness  of  one 


WHITLOW  313 

thigh,  and  feverishness.  The  limb  swells  slowly,  and  in  a 
few  days  will  be  very  white,  hard,  and  shining,  like  a  hard 
bolster  in  a  white  pillowslip.  The  veins  can  be  felt  as  hard 
as  whipcord  down  the  leg.  The  swelling  begins  to  go  down 
again  in  about  ten  days  and  the  leg  may  recover  altogether. 
But  very  often  some  degree  of  weakness  and  aching  remain 
in  the  leg  for  months  or  years. 

Treatment. — Rest  in  bed,  and  quiet,  with  the  limb  raised 
on  a  pillow.  At  the  onset,  give  the  patient  a  pill  contain- 
ing two  grains  of  quinine  and  %  grain  of  opium  every  six 
hours.  But  before  that,  administer  a  sharp  purge  like  a 
drachm  or  more  of  compound  jalap  powder.  Do  not  move 
the  leg  about,  or  poultice  it,  or  rub  it;  everything  depends 
on  its  being  kept  still.  Every  time  it  is  moved  there  is  a 
risk  that  a  piece  of  blood  clot  from  one  of  the  inflamed  veins 
may  be  dislodged  and  carried  by  the  blood  stream  to  some 
distant  part,  such  as  the  brain  or  lungs,  and  cause  fright- 
ful damage,  or  even  death.  This  mischief  is  called  em- 
bolism. 

White  Swelling. — This  is  the  name  given  to  tuberculous 
disease  of  a  joint,  especially  of  the  knee,  but  it  should  not 
be  used  by  those  who  care  for  accuracy. 

Whitlow. — This  is  a  name  given  to  almost  any  kind  of 
inflammation  of  the  fingers.  The  inflammation  is  caused 
by  a  germ  or  a  mixture  of  different  germs,  which  get  into 
the  blood  through  any  crack  or  tiny  sore  on  the  fingers, 
especially  at  the  edge  of  the  nails. 

Symptoms. — Throbbing  pain  in  a  finger,  made  worse  by 
hanging  the  hand  down,  relieved  by  raising  the  arm. 
Swelling  and  redness  and  tenderness  and  pain,  especially 
at  one  spot. 

In  the  least  severe  kind  of  whitlow  the  skin  rises  like  a 
blister  over  it  and  then,  if  the  blister  be  pricked  or  cut, 
matter  will  escape  and  the  whitlow  will  soon  be  well.  The 
second  and  more  severe  type  is  when  the  inflammation  is 
right  in  the  soft  pulp  of  the  flesh  of  the  finger,  especially 
likely  to  occur  after  getting  a  splinter  into  the  finger.  This 
kind  of  whitlow  is  to  be  continuously  fomented  or  held  in 
hot  water.  Presently  the  matter  comes  to  the  surface, 
bursts  through,  and  the  inflammation  gradually  subsides. 
The  third  and  really  serious  kind  of  whitlow  may  develop 
from  the  others  if  they  are  neglected.  The  inflammation 
goes  right  down  to  the  tendon  of  the  finger,  gives  intense 


314  WHOOPING  COUGH 

pain,  swelling  and  tenderness  all  up  the  arm,  swollen  glands 
in  the  armpit  and  a  general  feeling  of  illness.  If  neglected, 
this  whitlow  may  cause  loss  of  a  finger,  or  even  of  a  hand 
or  arm.  The  treatment  must  be  left  to  the  skill  of  a  sur- 
geon. 

Whooping  Cough. — This  is  a  very  contagious  disease, 
which  attacks  children  so  readily  that  very  few  children 
grow  up  without  suffering  from  it.  The  infection  of  the 
disease  seems  to  be  in  the  air,  and  we  suppose  that  the  out- 
breathed  air  and  the  phlegm  of  those  who  are  suffering 
from  it  spread  the  poison  which  starts  other  cases,  but  as 
yet  the  scientific  observers,  with  their  microscopes,  have  not 
been  able  to  discover  any  definite  germs.  The  disease  occa- 
sionally appears  as  an  epidemic,  attacking  a  large  number 
at  once  in  the  same  locality,  but,  in  general,  each  new  case 
is  infected  separately  from  a  previous  case.  For  example, 
a  child  may  get  the  infection  from  sitting  in  an  omnibus 
opposite  to  a  child  who  has  a  severe  fit  of  the  cough. 
Whooping  cough  is  called  Pertussis  by  doctors,  and  an  old 
English  name  was  Chin-cough.  It  rarely  occurs  more  than 
once  to  anyone. 

It  generally  begins  as  a  common  cold,  passing  on  to  a 
cough,  with  a  little  f everishness ;  and  then  after  a  week  or 
more,  the  cough  changes  its  character;  it  tends  more  and 
more  to  come  on  in  fits  of  coughing,  with  free  intervals. 
There  may  be  only  two  or  three  fits  of  coughing  in  a  day, 
or  as  many  in  an  hour.  The  cough  develops  a  peculiar 
quality  of  a  shrill  sound  or  whoop,  which,  once  recognized, 
is  hardly  ever  mistaken.  It  occurs  at  the  end  of  a  fit  of 
coughing,  when  the  patient  is  almost  strangled  by  the  length 
of  time  the  cough  has  lasted.  These  coughing  fits  may  end 
in  vomiting  or  in  nose-bleeding,  and  a  child  suffers  so  much 
in  them  that  he  dreads  each  onset.  Directly  after  a  fit, 
however,  the  patient  seems  to  regain  courage,  and  if  sick- 
ness has  occurred,  he  soon  gets  hungry  again.  Cases  gen- 
erally last  three  weeks,  but  children  may  continue  to  whoop 
for  three  months.  It  is  a  very  disagreeable  disease  for 
nurses  and  patients,  but  its  great  dangers  lie  in  the  com- 
plications which  are  so  apt  to  develop.  Measles  occasion- 
ally occurs  with  whooping  cough,  and  makes  the  child  even 
more  ill,  and  increases  the  danger.  Bronchitis  and  pleu- 
risy, and  also  pneumonia  and  congestion  of  the  lungs,  are 
the  most  common  and  most  dangerous  diseases  which  ac- 


WHOOPING  COUGH  315 

company  whooping  cough,  and  when  there  are  any  symp- 
toms of  either  of  these,  medical  aid  must  be  sought  for  at 
once.  The  severe  cough  is  also  liable  to  injure  the  ears, 
and  may  cause  bleeding  behind  the  whites  of  the  eyes ;  and 
even  convulsions  are  occasionally  set  up,  and  cause  great 
danger. 

Treatment.— Isolation  is  the  first  question  to  be  dealt 
with.  As  the  disease  will  last  for  eight  to  ten  weeks  or 
more,  it  is  no  use  to  begin  a  system  in  a  half-hearted  way. 
If  possible,  where  there  is  more  than  one  child  in  a  house, 
the  sick  one  should  be  sent  away ;  and  if  he  is  too  sick,  then 
the  other  children  must  be  sent  away.  The  child  ought 
really  to  have  two  rooms  to  use,  but  in  any  case,  from  the 
rooms  which  it  uses  everything  that  can  be  damaged  by 
disinfectants  must  be  removed,  because  the  rooms  will  have 
to  be  disinfected  afterwards.  The  child  must  be  warmly 
clothed,  but  must  have  plenty  of  fresh  air  and  not  be  cod- 
dled. When  we  come  to  mention  medicines  we  find  our- 
selves in  a  fix :  there  are  so  many  different  ways  af  treating 
the  disease.  We  always  discountenance  the  treatment  of  a 
disease  which  may  be  so  serious  as  whooping  cough,  with- 
out a  doctor,  and  we  know  that  most  doctors  have  their 
routine  way  of  dealing  with  it.  Yet  a  few  remarks  may  be 
useful.  The  disease  generally  runs  its  course;  very  little 
can  be  done  with  medicines,  and  a  great  deal  can  be  done 
by  good  nursing.  The  following  is  a  very  good  prescrip- 
tion for  a  two-year-old  child  with  whooping  cough : — Phena- 
zonum,  1  drachm;  ammonium  and  sodium  bromides,  of 
each  1  drachm;  syrup  of  chloral,  6  drachms;  chloroform 
water  to  4  ounces.  Give  a  teaspoonful  every  three  hours. 
Caution. — This  contains  poisons  and  must  be  given  only  in 
measured  doses. 

Additional  recipes  for  use  in  whooping  cough : — 

(1)  Yeo's  inhalation  method  of  treating  whooping 
cough.  An  iron  dripping-spoon  is  kept  on  the  fire  and 
carbolic  acid  is  dropped  on  to  it  and  evaporated  until 
the  air  of  the  room  is  full  of  carbolic  fumes.  The 
throat  of  the  child  to  be  painted  with  glycerin  of  car- 
bolic acid.  The  following  lotion  to  be  sprayed  in  front 
of  the  child's  face  (with  eyes  shut)  from  time  to  time 
— Glycerin  of  carbolic  acid,  1  drachm;  bicarbonate 
soda,  10  grains ;  hot  water,  1  ounce. 


316  WOEMS 

(2)  Instead  of  carbolic,  eucalyptus  or  terebene  may 
be  used. 

(3)  Resorcin    (2  per  cent.)    solution  may  be  both 
sprayed  into  the  room  and  painted  in  the  throat. 

(4)  Ipecacuanha  wine,  4  fluid  drachms;  ammonium 
bromide,  3  drachms ;  paregoric,  4  fluid  drachms ;  syrup 
of  tolu,  1  fluid  ounce;  chloroform  water,  to  4  fluid 
ounces.     A  child  of  seven  years  may  be  given  a  tea- 
spoonful  of  this  in  a  wineglassful  of  water  three  times 
a  day.     A  good  prescription. 

(5)  Another  useful  one  is: — Ammonium  chloride, 
25  grains ;  bicarbonate  of  soda,  40  grains ;  sodium  ben- 
zoate,  70  grains ;  chloroform  water,  1  fluid  ounce ;  anise 
water,  to  3  fluid  ounces.     A  teaspoonful  may  be  given 
to  a  child  of  four,  every  four  hours. 

Winter-Cough.. — There  is  no  cough  peculiar  to  the  winter. 
This  name  means  chronic  bronchitis,  which  is  worse  in  the 
cold  and  damp  weather  and  better  in  the  warm  weather. 
(See  "Cough"  and  "Bronchitis.") 

Worms. — Under  this  heading  we  describe  briefly  the 
principal  worms  which  are  sometimes  found  in  the  bodies 
of  human  beings,  especially  in  the  bowels  of  children. 

The  TAPEWORM  is  a  flat,  long  worm,  whitish,  like  a  piece 
of  tape  and  consisting  of  a  tiny  head,  with  suckers  which 
enable  the  worm  to  attach  itself  to  the  inside  lining  of  the 
bowel  and  to  draw  its  nourishment  from  thence;  a  thin 
tapering  neck  like  a  piece  of  white  thread ;  and  a  long  body 
of  several  separate  segments  or  divisions.  The  body  may 
be  as  long  as  a  yard  or  more,  and  the  whole  worm  lies  coiled 
up  in  the  bowel.  Bits  of  it  get  broken  off  from  time  to 
time,  and  appear  in  the  motions,  but  so  long  as  the  head 
holds  fast,  the  worm  does  not  die,  but  keeps  on  adding  seg- 
ments to  itself. 

Cause. — The  tapeworms  are  taken  into  the  body  by  eat- 
ing the  flesh  of  pigs  or  cattle  which  have  harbored  them. 
Pork  with  worms  in  it  is  called  "measly  pork,"  and  is  not 
uncommon  among  the  poorer  class  of  butchers'  shops. 
There  is  a  little  tapeworm  also,  which  is  sometimes  caught 
from  pet  dogs.  The  dog  picks  up  garbage  and  rubs  its  nose 
in  the  filth  of  the  gutter  and  then  may  communicate  worms 
to  anyone  who  allows  it  to  lick  his  face  or  touch  his  food. 

Signs  of  worms. — Children  with  tapeworm  generally  have 


THREADWORM  317 

enormous  appetites,  diarrhea  alternating  with  costiveness, 
headaches  and  even  fits  or  convulsions.  From  time  to  time 
you  can  see  several  inches  or  feet  of  tapeworm  in  the  mo- 
tions. 

Treatment. — (1)  Keep  the  child  in  bed. 

(2)  Give,  for  three  days,  a  very  spare  and  light  diet 
and  a  tabloid  or  two  of  cascara  sagrada  every  night.     This 
gets  the  bowels  free  from  much  solid  residue  of  food,  and 
makes  the  other  treatment  much  more  likely  to  succeed 
the  first  time, 

(3)  On  the  fourth  day,  at  nine  in  the  morning,  give 
patient  a  capsule  of  ten  minims  of  the  extract  of  male 
fern;  another  similar  dose  half-an-hour  later;  another 
again  at  ten  o'clock.     Then,  at  eleven  o'clock,  a  fluid 
ounce  of  compound  senna  mixture,  or  an  ounce  of  castor 
oil.     When  the  bowels  have  acted,  give  some  breakfast. 
The  reason  for  these  repeated  doses  is  that  if  only  a 
single  dose  is  given  it  may  pass  quickly  over  the  worm 
and  fail  to  kill  it. 

(4)  When  the  bowels  do  act,  the  motion  ought  to  be 
passed  into  a  bedpan  with  a  piece  of  black  thin  crape  or 
cloth  over  it.     Then  the  white  neck  and  head  of  the  worm 
may  easily  be  found. 

Until  the  head  has  been  found,  the  cure  cannot  be 
considered  to  have  been  accomplished.  It  is  very  small, 
hardly  bigger  than  a  pin's  head. 

THREADWORM. — The  threadworm  is  about  a  quarter  of 
an  inch  long,  white,  and  threadlike.  These  worms  live  in 
the  lower  bowel  or  rectum. 

Signs  of  threadworm. — Diarrhea,  nervous  irritability, 
and  even  fits ;  picking  of  the  nose,  scratching  of  the  funda- 
ment, grinding  of  the  teeth  during  sleep  and  bed-wetting. 

Treatment. — The  irritation  at  the  back  passage  may  be 
relieved  by  applying  weak,  white,  precipitate  ointment.  In- 
ternally the  child  should  have  one  santonin  lozenge,  at  bed- 
time, every  night,  for  a  week,  and  a  small  dose  of  castor  oil 
in  the  morning;  also  injections  of  warm  salt  water  or  sea 
water  into  the  back  passage. 

BOUND  WORM. — The  roundworm  looks  something  like  an 
ordinary  garden  worm,  only  pale  yellowish  in  color.  It  is 
about  ten  inches  long.  These  worms  live  in  the  bowels  and 


318  WRY-NECK 

feed  there ;  but  sometimes  one  wanders  into  the  stomach  and 
is  vomited  up,  or  into  the  nose,  and  may  even  try  and  get 
through  the  nostril.  These  worms  are  fond  of  getting  into 
round  openings.  They  cause  a  too-great  appetite,  varied 
sometimes  by  a  complete  loss  of  appetite,  and  sometimes 
diarrhea,  and  pain  in  the  belly. 

Treatment. — To  a  child  give  5  grains  of  santonin  in  one 
dose,  at  bedtime,  and  a  large  dose  of  castor  oil  in  the  morn- 
ing. 

Wry-Neck. — In  wry-neck  the  head  is  twisted  to  one  side. 
It  may  be  caused  by  the  scars  of  a  burn,  or  of  operations 
for  swollen  glands,  which  drag  the  head  over  to  one  side. 
But  by  far  the  most  common  sort  of  wry-neck  is  caused  by  a 
spasm  or  cramp  of  the  muscle  called  sterno-mastoid  which 
jerks  the  head  to  one  side,  often  in  a  very  painful  fashion. 
Tailors  and  shoemakers  are  very  liable  to  the  complaint. 
Infants  during  birth,  when  the  delivery  has  been  difficult, 
are  apt  to  suffer  from  a  rupture  of  the  sterno-mastoid  mus- 
cle, so  that  the  one  on  the  other  side  drags  the  head  over  to 
that  side. 

The  cure  of  every  case  of  wry-neck  must  depend  entirely 
on  its  own  merits  and  its  causes.  We  can  give  no  help  in 
these  pages. 


THE   END 


INDEX 


Topics  printed  in  small  capitals  are  found  also  in  their  regular 
alphabetical  place  in  the  body  of  the  book. 


abortion,  198 

ABSCESS,  1 

abscess  of  the  lung,  179 

absinthe,  286 

acetylene  gas,    174 

aconite,  in  fevers,  110;  for  sore 
throat,  264 

ACIDITY  (Sour  Stomach,  Heart- 
burn), 2 

ACNE.     (See  BLACKHEADS) 

acquired  syphilis,  277 

ADENOIDS,  3 

adenoids,  207,  212 

adhesive  plaster,  in  medicine 
chest,  186 

adrenaline,  for  bleeding,  224 

advertising,  273,  301 

AGE   AND   WEIGHT,    4 

ague,  182 

ALCOHOL,   ACUTE   POISONING   BY,    5 

alcohol,  as  skin  antiseptic,  12; 
as  food,  25;  for  sponging  in 
fevers,  110;  a  cause  of  in- 
sanity, 162;  in  insomnia, 
165;  unnecessary  drink,  193; 
secret  abuse  of,  204;  ex- 
cesses, 215,  221,  244;  in  ty- 
phoid, 293 

ALCOHOLIC  DRINKS,  MODERATION 
IN,  5 

alcoholic  drinks,  5;  abuse  of,  6; 
moderation,  7 ;  amount  in 
health,  8;  not  to  be  admin- 
istered for  apoplexy,  13,  236 

alcoholic  paralysis,  116 

alkaline  bath,  formula  for,  22; 
soap,  125 

alkaline,  mouth  wash,  78;  tooth 
powders  best,  78 


alkaloe,  12,  212 

aloe,  218 

aloe,   belladonna   and   strychnine 

pill,  69 
alum,    lotion    for    feet,    29;     for 

bleeding,  20S,  225,  227;   for 

sore  throat,  264 
alum  powder,  in  medicine  chest, 

187,  190 

aluminium  acetate,  for  abscess,  1 
amaurosis,  265,  266 
ammonia,  for  stings,  26 
ammonium  acetate,  in  fevers,  110 
ammonium  bromide,  208 
ammonia,  in  medicine  chest,  186 
arnputation?  117 

ANAEMIA,    8 

anemia,  132,  133,  149,  203,  227, 
287,  306 

ANAESTHETICS,    10 

anasarca   ( see  DROPSY  ) ,  89 

ANEURISM,    10 

aneurism,  289,  305 

ANGINA  PECTORIS,    11 

anise,  57 

antinomy,    for    eczema,    96;    for 

sore  throat,  204 

antipyrin,  110,  132,  158,  264,  297 
ANTISEPTICS,  11;  list  of,  112 
antitoxin,  diphtheria,   73,   84 
anus,  the,  217 
anyl  nitrate,  for  angina  pectoris, 

11 

apenta  water,  69 
APOPLEXY,  12 
apoplexy,  211 

APPENDICITIS,    13 

APPETITE     GOOD,    BAD    AND    INDIF- 
FERENT,   14 


319 


320 


INDEX 


aristoe,  antiseptic  powder,  12 

armpits,  lotion  for,  217 

arnica,    tincture    of,    for    stings, 

26;  not  to  be  used  for  gout, 

123 
aromatic  chalk  powder,  in  medi- 

chine  chest,  187 
Arsenic  for  boils,  31;  for  eczema, 

96,   223;    in   psoriasis,   229; 

poisoning,  288 
arterio-sclerosis,  305 
artificial   feeding,    154;    lighting, 

172 

arthritis,  234,  238 
artificial  respiration,  90 
ASCITES,  16 
ashes.  234 
aspirin,    for    lumbago,    178;    for 

rheumatism,  235 
asses'  milk,  196 
ASTHMA,  16 
asthma,  206 
asthma  powders,  17 
asylums,  160 


BABIES     LOST    BY    OVERLAYING    IN 

BED,    18 
BACKACHE,    19 

bacon,  64.     (See  also  DIETS) 
bacteria,  in  milk,  194-5 
ballin  bottle,  196 
bandages,  in  medicine  chest,  186, 

188 
bandage,  for  bleeding  in  varicose 

veins,     29;     for    abscess    of 

breast,  31 

BANTING,    20 

banting,  67 

BARBERS'  ITCH,  21 

BARLEY  WATER  FOR  INVALIDS,  21 

barley  water,  48;  in  measles,  185 

BARRENNESS,    20 

BATHING,      THE     IMPORTANCE     OF, 
22 

baths,    214;    conium,    167;    sul- 

phuret,  167 
Baume  AnalgSsique  Bengue1,  for 

gout,  123 

beans,  in  diabetes,  80 
BED  CASE;  23 

BEDSORE,    23 

bedsores,  293 


BEEF  TEA,   HOW  TO   MAKE,   23 

beef  juice,  48;  tea,  for  influenza, 

158 

beer,  25,  216 

belching,  false  relief  of,  152 
belladonna,  for  bruises,  34 
benzoin,  189;  for  tonsils,  264 

BEVERAGES,   24 

bicarbonate  of  potash,  in  rheu- 
matism, 235,  239 

bicarbonate  of  soda,  for  teeth, 
282;  for  tongue,  287,  297 

bichloride  of  mercury,  28 

bichloride  of  mercury  (corrosive 
sublimate),  for  cuts,  29; 
for  boils,  31;  for  abscess,  1; 
as  antiseptic,  12;  as  disin- 
fectant, 86 

bicycles,  for  reducing,  67 

bilious  attacks,  271 

birthmarks,  25,  292 

bismuth,  144 

BITES    AND   STINGS,    26 
BITES   OF   DOGS,    26 

black  and  blue,  268 

BLACK-EYE,    27 
BLACKHEADS,    27 
BLADDER,    DISEASES    OF,    28 

bladder,  299 
blankets,  235 

Blaud's  pills,  for  anaemia,  10 
blebs,  253 

bleeding,  in  scurvy,  247;  wash- 
ing wounds,  283 

BLEEDING  FROM  VARICOSE  VEINS, 
28 

blister,  for  ear  noises,  207 
blistering,  for  lumbago,  178 
blood-poisoning,  230,  253,  287 

BLOOD- SPITTING,    30 
BLOOD-VOMITING,   30 

blue  mass,  in  fevers,  110 

blood,  in  rickets,  240 

blue  pill,  for  liverishness,  69 

BOILS,  30 

Boracic    acid,    as   antiseptic,    12, 

212 
boric   acid   for    eczema,    97 ;    for 

barbers,     26 ;     for     shingles, 

144;  in  scurf,  246 
boric   acid    powder,    in    medicine 

chest,  187,  189 
boric  lint,  40,  297 


INDEX 


321 


boric   lotion,   for  black   eye,   27; 

ointment     for     housemaid's 

knee,  146 

borine,  as  toilet  antiseptic,  12 
/boroglyceride,  246 
borolyptol,    as    toilet    antiseptic, 

12 

bottles,  for  feeding,  196 
bowels,   192,   203;   in  pregnancy, 

227;    in    rheumatism,    237; 

with  ulcers,  297,  307 

BRANDY    AND    EGG    MIXTURE,    31 

brandy,  amount  of  alcohol  in,  25 ; 
for  diarrhoea,  48;  in  col- 
lapse, 200;  after  poisoning, 
222 

bread  poultice,  226,  264 

break-bone  fever,  198 

BREAST,    ABSCESS   OF,    31 

breast  feeding,  195 

breasts,   bandaged  in  pregnancy, 

227 
breath,  153,  192 

BREATH,  UNPLEASANT  OR  FOUL, 
32 

breath,  shortness  of,  32 

breathing,  exercises  for  bust  de- 
velopment, 36 

BRIGHT'S  DISEASE,  32,  168,  230, 
299 

brimstone,  218 

BROKEN  BONES,    32 

bromide  of   sodium,   for  seasick- 
ness, 247 
bromides,  165 
bromine,  for  epilepsy,  101 
bromural,   for   insomnia,    166 
BRONCHITIS,  33 
bronchitis,  184,  289,  314 
BRUISES,  34 
brushes,  186 
brushes  and  combs,  245 
brush,  throat,  188 
BUBO,  34 
bubo,  120 
bug  bites,  233 
BUNION,  35 

BURNS,   35 

BUST  DEVELOPMENT,    36 

buttermilk,  substitute  for,  170 


cachous,  useless,  32 


caffeine,  132;  in  medicine  chest, 

187 

calamine  lotion,  for  eczema,  95 
calcium  phosphate,  207 
calomel,   for   boils,   31;    for  gall 

stones,     117;     in     medicine 

chest,    187,    189;    for    piles, 

218;  in  sciatica,  243;  for  ul- 
cers, 297 

camphor  liniment,  178 
camphor,  water,  in  chicken  pox, 

45;  for  chilblains,  46 
CANCER,  37 
cancer  of  the  liver,   176;   of  the 

stomach,    272;    tongue,    286, 

292,  308 

candle  light,  173 
carbolic  acid,  12;  in  chicken  pox, 

45;     poisoning    from,     222; 

disinfectant,    246;    for    stye, 

274 
carbolic  acid  lotion,  in  medicine 

chest,  187 
carbolic  oil,  for  catheter,  40;  for 

barbers,   126;   for  scurfiness, 

257 
carbolic    soap,    40;    in    medicine 

chest,  186,  188 
carbolic  tooth  powder,  282 
carbonate  of  soda,  for  scaliness, 

230 

CARBUNCLE.     (See  also  GLANDS) 
carre"  ammonia  process,  139 
carron  oil,  for  burns,  36 
carrots,    in    diabetes,    80.     (See 

DIETS) 

cascara,  10,  69 

cascara  sagrada,  227,  230,  317 
castor    oil,    for    eczema,    96 ;    in 

medicine     chest,     187;     for 

poisoning,     200;     in     piles, 

218;  as  purge,  230,  293 
cataract,  265,  266 

CATARACT.       (See  EYE   DISEASES) 
CATARRH.       (See      COLD      IN      THE 
HEAD) 

catarrh,  74,  263 

catarrh  of  the  stomach,  215 

catechu,  for  sore  throat,  264 

CATHETER,    39 

cauliflower,  in  diabetes,  80.     (See 

DIETS) 
caustic  potash,  286,  308 


322 


INDEX 


celery,  avoid  in  asthma,  17 
champagne,  for  tonic,  39 
CHANCRE,  40 
chancre,  277,  278 

CHANGE   OF   AIR,   41 

CHANGE   OF  AIR  AS   A   REMEDY,   42 

CHANGE   OF  LIFE,   43 

cheese,  to  be  avoided  in  asthma, 
17;  in  consumption,  64. 
(See  also  DIETS) 

cheese  cloth,  for  filtering  air,  92 

cess  pools,  249 

chaps,  254 

charcoal  poultice,  226 

CHEST,    DEFORMITIES    OF,    44 
CHICKEN   POX,   45 

chicken  pox,  232,  300 

CHILBLAINS,    45 

chilblains,  254 

childbirth,  298 

child  crowing,  46 

chills,  in  scarlet  fever,  243 

chloral,  227 

chloral,  overindulgence,  165 

chlorate  of  potash  lozenges,  289 

chloride  of  lime,  86 

chloride  of  zinc  for  sore  throat, 

264 

chlorobrom,  in  seasickness,  247 
chloroform,  as  anaesthetic,  10 
chlorosis,  9 
chocolate,  25 
CHOKING,  46 
cholalogues,  230 

CHOLERA,    47 

cholera,  248 

Christian  Science,  not  for  broken 
bones,  33;  chancre  or  syph- 
ilis, 41 

chrysarolin  ointment,  229 

cider,  25 

cigars,  285 

cigarette  smoking,  201,  284 

CIRCUMCISION,  48 

circumcision,  111,  298 

cirrhosis  of  the  liver,  175,  215; 
stomach,  215 

citrate  of  magnesia,  69,  230 

claret,  25 

Clark,  Sir  Andrew,  9 

CLEANING,    48 

cleanliness,  for  blackheads,  3 


CLIMATE    FOR    INVALIDS,    50 

clothing,  215 

cloves,  oil  of,  287 

coal  gas,  173 

cocoa,  25 

cocaine,  10;  and  bismuth  oint- 
ment, 69;  for  ulcers,  297, 
312 

codeine,  in  diabetes,  81 

codliver  oil,  for  acne  33;  chil- 
blains, 45;  for  consumptives, 
64;  for  coughs,  71;  for  rick- 
ets, 239;  for  spine  disease, 
267 

coffee,  antidote  for  opium  pois- 
oning, 25;  for  headaches  in 
anaemia,  133 

coffee,  after  poisoning,  222 

colchicum,  in  fevers,  110;  wine 
for  gout.  123,  1781;  for  gout, 
239 

cold  baths.      (See  BATHING) 

cold  cream,  27 

COLD  IN  THE  HEAD  (Nasal  Ca- 
tarrh), 56 

cold  in  the  lip,  144 

COLD-ON-THE-LIP,    57 

colds,  214 
COLIC,  57 
colic,  155,  223 
collapse,  58 
colocynth,  218,  230 
cologne  poultice,  226 
coma,  in  diabetes,  80 
COMA,  58 

CONCUSSION         OF         THE         BRAIN 

(Stun),  58 
confinement,  calculation  for,  227 

CONFINEMENT,    59 

congenital  syphilis,  276 
conium  ointment,  for  piles,  218 
conjunctiva   (see  EYE  DISEASES), 

105,  214 

constipation,  69,  218 
CONSUMPTION,  59 
consumption,  64,  245,  289,  292 
convulsions   (see  FITS),  111 
Cooper-Hewitt  light,  173 
cornea,  clouds  on,  265 
cornea  (see  EYE  DISEASES),  106 
corn  plasters,  66 
corn  solvents,  66 


INDEX 


323 


CORNS  AND  BUNIONS,  66 
CORPULENCE  OR  OBESITY,   66 

corrosive  sublimate,  in  catheter- 
ization,  40;  (see  also  bi- 
chloride of  mercury)  for 
barbers,  126,  223 

corsets,  215 

COSTIVE   BOWELS,    68 

costiveness,  230 
cotton  wool,  for  stings,  26 
country,  superior  vitality  in,  42; 
good  for  children,  43 

CRACKED   NIPPLES,    71 

CRAMP   IN   THE  CALF  OF   THE   LEG, 

cramps,  71 

cream  of  tartar,  230 

CREMATION,    71 

creosote,  in  medicine  chest,  187 
189,  287 

CRETINISM,    72 

cricket,  273 

cross-eyes,  269 

croton  oil,  for  ulcers,  297 

croup,  72 

cubeb  cigarettes,  17 

curly  hair,  128 

cut  throat,  73 

cyanide  of  potash,  222 

cystitis   (see  BLADDER),  28 


dandruff,  245 

DEAFNESS,    73 

deafness,  289 

DEATH,    SUDDENj    75 
DELIRIUM  TREMENS,   76 

delirium    tremens,    "D.    TVs,"    5, 

77,  197,  286 
demented  persons,  197 
dental  hospitals,  282 

DENTAL  HYGIENE,  77 

depilatory,  129 
dermatol,  12 
DIABETES,  78 
diabetes,  299 

DIARRHEA,    81 
DIARRHEA  IN  BABIES,    82 

diarrhea,  in  children,  2;  in  con- 
sumptives, 64;  infants,  155; 
summer,  194,  196;  rickets, 
207 ;  poisoning,  233,  248,  270 


Diet 

for  consumptives,  64 

for  constipation,  69 

diabetes,  80 

epilepsy,  101 

gall  stones,  117 

gout,  124 

milking  mothers,  154 

infants,  155 

pneumonia,  220 

rheumatism,  236 

rickets,  240 

seasickness,  247 

teeth,  282 

athletic  training,  290 

typhoid,  293 

vegetarian,  303 

modified  vegetarianism,  304 
Diet  in  relation  to  age  avid  ac- 
tivity, 194,  305 

DIGESTIBILITY,    83 

digitalis,  for  the  ear,  207 
dilated  stomach,  271 
dill  water,  57 

DIPHTHERIA,    83 

diphtheria,    110,    162,    194,    196, 
248,  263 

DIPSOMANIA,    84 

disinfectants,  in  typhoid,  294 

DISINFECTION,    80 
DISLOCATION,    86 
DOSAGE,    86 

Dover's   powders,    110,   188,   190, 
243 

DRACHMS  AND  OUNCES,   87 

drainage,  for  mosquitoes,  198 

DREAMS,    88 

dress,  in  pregnancy,  227 

DRINKING    CUP,    88 

dropsy,  230,  243 
DROPSY,  89 
DROWNING,  89 
drunkards,  299 
drunkenness,  230 
dry  cupping,  178 
Dunbar's  pollantin,  for  hay  fever, 
131 

DUST,    91 

DYSPEPSIA    (866  INDIGESTION),   93 

EAR  DISEASES,  93 

ear,  the,  224,  242 


324 


INDEX 


ear  syringe,  186 

earth  closet,  248 

ECZEMA,  94 

eggs,  69,  83.     (See  also  DIETS) 

egg  julep,  for  baldness,  20 

egg-nogg,  formula  for,  31 

elastic  ulcer,  303 

electric  light,  172 

electricity,  204,  211 

electrolysis,  for  birthmarks,  25; 

superfluous  hair,  129 
elephantiasis,  198 
embolism,  221 
emetics,  200 
EMETICS,  98 
emphysema,  289 
empyema,  219 
ENEMA,  98* 
enteric  fever,  292 
epileptics,  197 
EPILEPSY,  99 
epilepsy,  111,  216,  298 
epithelioma,  308 
epsom  salts,   187,  189,  200,  230, 

297 
epsom  salts,  in  fever,  110;  after 

poisoning,  223 
eruptions,  of  beggars  and  tramps, 

231;    from    external    agents, 

231;  in  syphilis,  277,  288 

ERYSIPELAS,    102 

erysipelas,  253 

ether,  anaesthetic,   10;   compound 
spirits  of,  for  hiccough,   144 
ethyl  chloride,  10 
ethylate  of  soda,  308 
eucaine,  10 
eucalyptol,  for  toilet  use,   12 

EXERCISE    AND    RECREATION,    103 

eye  bath,  1S6 

EYE    DISEASES,    105 

eye-strain,  214 
eyes,  213 
eythema,  255 

FAINTING,  108 

fasting,  152 

fat,  193 

feather  duster,  to  'be  avoided,  49 

feeding  cup,  186 

feeding,  for  children,  153-156 

feet,  lotion  for  sweating,  217 

femoral  hernia,  140 


ferric  chloride  for  ingrowing  toe 

nails,  285 

ferric  perchloride,  218 
FEVEB,  109 
feverish  colds,  188 
figs,  230 
filariasis,  198 
filters,  311 
fireplaces,  138 
first  aid,  drowning,  90 
fish,  64.     (See  also  DIETS) 
FITS,  111 
fits,  13,  278 
flatulence,  152 
flies,  195,  294 
FLIES,  112 
fly  paper,  114 

FOMENTATIONS,    114 

fomentations,  better  than  poul- 
tices, 225 

FOODSTUFFS  EXPOSED  TO  STREET 
DUST  AND  DIRT,  115 

football,  273 

foreskin,  too  tight,  28;  cleanli- 
ness in,  48;  tightness,  299 

formaldehyde  gas,  8*5 

Formamint  lozenges,  for  sore 
throat,  264 

freckles,  255 

Freeman's  pasteurized,   155,   196 

fresh  air,  for  cholera,  47 

Friar's  balsam,  46:  in  medicine 
chest,  187,  189 

fruit  jellies,  236 

fruits,  303.     (See  DIETS) 

GAIT   AND   APPEARANCE,    116 

gallstone,  176 

GALLSTONES,    117 

galls  and  opium  ointment,  218 
game,  202.      (See  DIETS) 

GANGRENE,  Or  MORTIFICATION,  117 

gangrene  of  the  lung,  179 
garbage,  114,  234 
gastritis,  271 

GENERAL  PARALYSIS,    117 

gentian,  tonic,  201 
German  measles,  185,  233 
GIDDINESS,  118 
gin,  25 
gingerbread,  69 

GLANDS,    SWOLLEN,   119 

glaucoma,  265,  266 


INDEX 


325 


glycerine,  for  cracked  nipples,  71 
glycerine    of    the    subacetate    of 

lead,  187,  188 
glycerine    of    tannin,     for    nose 

bleeding,  208 
glycerine    suppository    for    piles, 

69 

glycothymoline,  212 
goat's  milk,  111 

GOITER,  OB  DERBYSHIRE  NECK    (see 

also  CRETINISM),  120 
gold  fish,  199 

GONORRHEA,    121 

gonorrhea,  120,  216,  305 

Gordon,  Alexander,  184 

GOUT,  122 

gout,    9,    11,    17,   216,    228,    244, 

297,  299,  303 
granular  lids,  107 
grates,  as  ventilators,  137 
gray  hair,  128 
gray  powder,  187,  190 
grease,  on  hair,  127 

GROG   BLOSSOMS,    124 
GUMBOIL,  125 

gummata,  278 
gut,  the,  13 
gymnastics,  273 

Hahnemann,  145 

hair,  the,  64,  213;  loss  of,  256 

HAIRDRESSERS,   HINTS   TO,    125 
HAIR,  HOW  TO  TAKE  CARE  OF,    127 
HAIR,    LOSS    OF     ( S66    BALDNESS ) , 

129 
hair  wash,  a,  20 

HAIRS,   SUPERFLUOUS,    129 

hallucination,   180 
hamamelis  and  cocaine,  218 
hamamelis  ointment,  187 

HANGING,    129 

HANGNAIL,    130 

HARELIP,    130 

HAY   FEVER,    130 

HEADACHE     (VARIETIES    OF),    131 

headache,  169,  193 

HEALTH   RESORTS.        (See  CLIMATE 

FOR    INVALIDS) 
HEARTBURN,    133 

heartburn,  152 

HEART  DISEASE,    133 

HEATING,    136 

HEATSTROKE    (SUNSTROKE),   139 


hematocele,  143 
hemiplegia,  210 
hemisine,  for  bleeding,  224 
hemorrhoids,  217 

HERNIA,  OR  RUPTURE,  140 
HERPES,  143 
HICCOUGH,  144 

Higginson  Syringe,  99,   186,  222 
hip  baths,  28;  for  piles,  2181 

HIP-JOINT  DISEASE,    144 

hip-joint,  116 
hockey,  273 
holidays,  275 

Holt,  153;  formula  for  modified 
milk,  154 

HOMEOPATHY,    145 

honey,  69,  230.      (See  DIETS) 

hook-worm,  248 

hot-water  bottle,  223 

HOUSEMAID'S  KNEE,  146 

humidity,  in  heating,  138 

Hunyadi  Janos,  69 

Hutchinson,  ointment  for  psori- 
asis, 229 ;  plan  for  ring- 
worm, 258 

hydrobromic  acid,  101 

hydrocele,   142 

HYDROCELE,   146 

hydrophobia  ( see  BITES  OF  DOGS  ) , 

26 

hydrothorax    (see  DROPSY),  89 
hydrotherapeutic  baths,  214 
hypnotism,  204 

HYPOCHONDRIASIS  OR  NEURAS- 
THENIA,, 147 

hysteria,   132,  204,  206,  216,  299 

HYSTERIA,    148 

ice,  for  consumptives,  62 
ice  bag,  for  appendicitis,  14,  220 
ichthyol,   for   chilblains,   46;    for 
red  nose,  125 

IDIOSYNCRASY,    150 

illusion,   180 

IMPERIAL   DRINK,    151 
IMPOTENCE,    151 

incinerators,  234 
incontinence  of  urine,  298 
incubation,  periods  of  in  fevers, 

109 

incubation,  typhoid,  298 
Indian  clubs,  280 

INDIGESTION,    151 


326 


INDEX 


INFANT  FEEDING,   153 
INFANTILE   PARALYSIS,    156 
INFLAMMATION.        (See    ABSCESS) 
INFLUENZA,    157 

influenza,  162 
inguinal  hernia,  140 
inhaling  cigarettes,  284 
INSANITY,  158 
insanity,  196,  216 

INSOMNIA,    164 

intertrigo,  276 

intestines,  213 

iodide  of  potassium,  150?  239 

iodide  of  sodium,  for  asthma,  17 

iodine,    for    chilblains,    46;     for 

housemaid's  knee,  146,  187 
iodine,  tincture  of,  as  skin  anti- 
septic, 12 

iodoform,  antiseptic  powder,  12 
ipecacuanha,  as  emetic,  200 
ipecacuanha    wine,    in    medicine 

chest,  187,  190 

iron,  for  anaemia,  9;  for  boils, 
31;  for  bleeding,  225;  for 
sore  throat,  264;  syrup  of, 
267 

ironing  lumbago,  177 
iron  tonics,  for  hysteria,  150 
ITCH,  166 
ITCHING  OF  THE  SKIN  OF  VARIOUS 

PARTS,    166 

jalap,  218,  230 
Japanese  furniture  polish,  49 
jaundice,  198 

jellies,     for     consumptives,     64. 
(See  DIETS) 


kerosene,    173;    for    m( 
198;  for  lice,  213 

KIDNEY  DISEASES,   168 

kidneys,  disease  of,  a  cause  of 
anaemia,  9;  of  apoplexy,  12; 
in  diabetes,  15,  19,  111;  in 
gout,  122,  198;  alcoholic, 
215;  in  rheumatism,  237;  in 
Salisbury  treatment,  240;  in 
scarlet  fever,  242 

KOUMISS,   HOME-MADE,    170 

Lady  Webster  pill,  69 
lanolin,  for  black  eye,  27 


laudanum,    190;    for    poisoning, 

222;   for  ulcers,  297 
laxative  salts,  31 
laxatives,  69,  218 

LEAD    POISONING,    170 

lead  poisoning,  203,  288 
leeches,  93,  220 
lemon  juice  for  tongue,  287 
lemonade,    in    measles,    185;    in 

rheumatism,  236 
lemon  water,  56 
lens   (see  EYE  DISEASES),  106 
lice,  213 
LICE,  171 
licorice,  218 
licorice  powder,  69 
LIGHTING,  172 
lime,   as   disinfectant,    113,   249; 

syrup   of,    267;    in  typhoid, 

294 

lime  water,  223,  308 
liniments,  204 
linseed  jacket  poultice,  220 
linseed  poultice,  226 
linseed    meal    poultice,    for    sore 

throat,  264 
lint,  186,  230 

liquor  antisepticus  alkalimis,  191 
Lister,  Lord,  102 
listerine,  12 
liver,  congestion  of,  287 

LIVER,    DISEASES    OF    THE,    174 

liver,  the,  gO,  81,  218,  230,  240, 

278 

liver  colic,  176 
lobelia,  17 

LOCKJAW.     (See  TETANUS) 
lockjaw,  283 
locomotor  ataxy,  116,  305 

LOCOMOTOR  ATAXY,    176 

lotion,  for  eczema,  97;    for  lice, 

171;  for  scurfmess,  257 
lumbago,  234,  236 
LUMBAGO,  177 
lunar  caustic,  308 
lungs,  212,  220 

LUNGS,    DISEASES    OF   THE,    178 

lymphatic  glands,  in  syphilis,  277 

MADNESS,    SYMPTOMS    OF,    179 

magnesia,  218,  223,  256 
maize,  69 
malaria,  198 


INDEX 


327 


male  fern,  extract  of,  for  worms, 
317 

MALIGNANT,    183 

malt,     for     chilblains,     45;     for 

cough,   71 
malt  extract,  64;  in  rheumatism, 

236 

maltine,  64,  267 
maniacs,  197 

manure  piles,  breed  flies,  112 
mare's  milk,  196 
marriage,  cure  for  hysteria,  132, 

216 

MASSAGE,    183 

massage,  for  cramps,  71;  for 
paralysis,  211;  for  sprains, 
268 

masturbation,  149 

MEASLES,  184 

measles,  232,  253 

measure,  186 

meats,  83 

meat  extracts,  236.     (See  DIETS) 

MEDICINE   CHEST,    186 

medicines,    avoid,    unless    recom- 
mended by  doctors,   151 
melancholies,  197 
Meni£re's  disease,  119 
meningitis,  312 

MENINGITIS,    191 
MENSTRUATION,    191 

menstruation,  227 

methylated   spirits,    for   bedsore, 

23 

mercury,  for  syphilis,  279 
mercurial  poisoning,  289 

MIDDLE-AGED   MAN,   The,    192 

migraine,  132 

MILK,  194 

milk,  in  constipation,  69;  modi- 
fied by  Holt's  formula,  154; 
in  measles,  185;  as  antidote, 
223;  in  rheumatism,  236 

MELK,  ARTIFICIAL  HUMAN,    195 

milk  diet,  for  appendicitis,  14; 
for  asthma,  17;  milk  foods 
in  constipation,  164 

MIND  FAILURE,  196 

mineral  waters,  for  gallstones, 
117 

MISCARRIAGE,    CAUSES    OF,    197 

miscarriages,  276 
monomaniacs,  197 


Moore  system,  173 
morning  sickness,  228 
morphine,  for  lead  poisoning,  288 
morphine,  in  sleeplessness,  165 

MORTIFICATION.       ( See  GANGRENE  ) 
MOSQUITOES,    198 

mosquitoes,  183 

MOTHER'S    MARKS.     (See   BIRTH- 
MARKS ) 
mouth,  the,  212 

MUCOUS    MEMBRANES,    199 

mud  baths,  177 

MUMPS,  199 

mushrooms,  202 

MUSSELS,  200 

mustard,  in  warm  water,  for  al- 
coholic poisoning,  5;  bath, 
prescription  for,  22,  57 

mustard  poultice,  226 

mustard  and  water,  emetic,  200, 
222 

muzzling  dogs,  27 

nails,  213 

nasal  sound,  208 

naso  pharynx,  212 

NERVOUS    DEBILITY,    200 
NETTLERASH,    201 

nettlerash,  233,  255 

NEURALGIA,    202 

neuralgia,  17 
neuralgia- jaw,  287 

NEURASTHENIA,    204 

neurasthenia,  312 

NEURITIS,  ALCOHOLIC,  205 
NEUROSIS,   206 
NIGHTMARE,    206 
NIGHT-TERRORS,  207 
NIGHT    SWEATS,    207 

nipples,  in  pregnancy,  227,  228 
niter,  spirits  of,  in  fever,  110 
nitrate  of  potash,  for  asthma,  17 
nitric  acid,  308 
nitrous  oxide  gas,  10 
nodes,  278 

NOISES   IN   THE   EAR,   207 

nose,  212 

NOSE-BLEEDING,    208 

nuts,  bad  for  asthma,  17,  303. 
(See  DIETS) 

oatmeal,  in  rheumatism,  236 
observation,  116 


328 


INDEX 


obstetric  belt,  227 

oedema   ( see  DROPSY  ) ,  89 

Oertel  system,  67 

oiled  silk,  186,  230 

olive  oil,  64 ;  for  eczema,  97 ;  for 

lice,  213 

onion  juice,  for  stings,  26 
onion  poultice,  226 
open  air,  cure  for  colds,  42;  for 

consumption,  63,  201 
operation,  for  neuralgia,  204;  for 

piles,     218;     for     cross-eyes, 

269;   varicocele,  302 
ophthalmia    (see  EYE  DISEASES), 

106,  213 
opium,     in     diabetes,     80;      for 

eczema,  96;  for  ulcer,  297 
ovaries,     in     mumps,     200;      in 

syphilis,  278 
overeating,  218 

OVERLAYING.       (See  BABIES   LOST) 

overwork,  118 
oxalic  acid,  poisoning,  222 
oxide  of  mercury  ointment,  274 
oxygen,   179;   in  pneumonia,  221 
oysters,  digestibility  of,  83,  287. 
(See  also  DIETS) 

OYSTERS,   RISK  OF  EATING,   208 

pail  system,  the,  248 

PAIN,  209 

palsy,  286 

paralysis,  12,  278,  298,  305 

PARALYSIS,  210 

paralytic  insanity,  197 

paranoia,  162 

paraplegia,  210,  211,  305 

paregoric,  in  medicine  chest,  187, 

190 

paresis,  211 
Pasteur  treatment,  27 
Pasteurized  milk,  195,  294 
pastils,  186 
pastries,  17,  64,  236.      (See  also 

DIETS  ) 

PATHOLOGY,    211 

peas,  in  diabetes,  80.      (See  also 

DIETS ) 

peeling,  in  scarlet  fever,  242 
peppermints,  for  seasickness,  247 
pepsin,  in  consumption,  64 
perchloride,  for  bleeding,  223 


perchloride  of  iron,  for  erysip- 
elas, 103 

perforated  ulcer,  272 

peroxide  of  hydrogen,  3;  anti- 
septic, 12;  for  cuts,  29;  for 
bruises,  34;  for  tetanus,  283 

PERSONAL   HYGIENE,   211 
PERSPIRATION,   217 

phenacetine,     132;     in    medicine 

chest,  187,  190 
phenol,  218 

phosphate  of  soda,  230 
phosphorus,  133,  223 
phosphorus  poisoning,  289 
phthisis,  287 

PHYSIOLOGY,    217 

pickles,    avoid    in     asthma,     17. 

(See  also  DIETS) 

picrotoxin,  for  night  sweats,  207 
piles,  9,  187 
PILES,  217 
pimples,  27-28,  253 
pipes,  best  for  smoking,  284 
plastermulls,  97 
Platt's  Chlorides,  86 
plenum  system,  138 

PLEURISY,    219 

plug,  for  epileptics'  jaws,  102 

plumbing,  good,  249 

PNEUMONIA,  220 

pneumonia,  184,  314 

podophyllin,  for  gallstones,  117 

poison,  150,  186 

POISONING,  221 

pollatin,  Dunbar's,  131 

polypus,  207 

POLYPUS,  223 

pomatum,  on  hair,  127 

Poplar  charcoal,  152 

poppy-heads,  fomentations  of,  for 
black  eye,  27 

pork,  bad  for  asthma,  17.  (See 
also  DIETS) 

porter,  bad  for  asthma,  17.  (See 
also  DIETS) 

potassium  permanganate,  in  te- 
tanus, 283 

potassium  permanganate,  as  anti- 
septic, 12 

potatoes,  in  diabetes,  80.  (See 
also  DIETS) 

POULTICES,  225 


INDEX 


329 


poultices,    for    appendicitis,    14; 

for   black   eye,    27;    not   for 

gout,    123;    in   mumps,    200. 

( See     also     FOMENTATIONS, 

114) 
pregnancy,  191,  208,  218 

PREGNANCY,    HYGIENE    OF,    227 

prescriptions,,  for  colds,  34,  56; 
for  the  skin,  37 ;  for  cholera 
morbus,  48;  for  cough,  57. 
(See  also  RECIPES) 

prevention  of  disease,  v-vi,  162, 
192,  294 

PREVENTION   OF  INSANITY^    162 

privates,  itching  of  in  diabetes, 
8*0 

privy  vaults,  114 

prostrate  gland  (see  BLADDER), 
28,  299 

proud  flesh,  296 

prunes,  69,  230.    ( See  also  DIETS  ) 

prurigo,  166 

pruritus,  167 

Prussian  blue,  223 

Prussic  acid,  222 

psoriasis,  253,  278 

PSORIASIS,  228 

pulse,  in  pleurisy,  219 

puncture,  for  lumbago,  178 

pupil  (see  EYE  DISEASES),  105 

purgatives,  for  acne,  3 ;  not  for 
appendicitis,  14;  for  head- 
aches, 133,  187.  (See  also 
DIETS ) 

PURGATIVES,    230 

pus,  1,  3 

pustule,  253 

pyaemia,  287 

pyridine,  for  asthma,  17 


quack  medicines,  200 

quarantine,   after  fevers,   110 

quassia,  201,  297 

quinine,  for  eczema,  96;  for  tem- 
perature, 110;  for  malaria, 
182,  188,  201;  for  sore 
throat,  264 

quinine,  ammoniated  tincture  of, 
for  influenza,  158 

quinsy,  264 

QUINSY,  231 


rabies,  26 

rash,  110,  232,  242,  276 

RASHES  ON  THE  SKIN,  ARTIFICIAL, 

231 

RECIPES 

consumption,  64 

cough  s;  70 

tooth  powder,  78 

diarrhea,  82 

disinfectant,  85 

eczema  powder,  96 

eczema  cold  cream,  97 

various  emetics,  QS 

enema,  99 

ophthalmia,  106 

gout,  124 

for  barbers,  126,  127 

scanty  hair,  127 

superfluous  hairs,  129 

flatulence,  152 

water  brash,  152 

foul  breath,  153 

conium  baths,  167 

lead  poisoning,  171 

drunkenness,  175 

measles,  185 

neuralgia,  203,  204 

neuritis,  206 

sweating  in  consumption,  207 

polypus  in  womb,  224 

wind  in  the  stomach,  230 

purge  in  rheumatic  gout,  230 

anaemia,  230 

purge  in  dropsy,  230 

laxative  for  children,  231 

rheumatism,  237 

sore  throat,  243 

sciatica,  244 

dandruff,  246 

scurf,  246 

painful  menstruation,  192 

stomach  discomfort,  272 

white  leg,  313 

whooping  cough,  315 
rectum,  the,  217,  222,  223 
red  gum,  255 
RED  GUM,  233 

REFUSE  DISPOSAL,    234 

retention  of  urine,  299 
retina   (see  EYE  DISEASES),  106 
rhatany,  for  sore  throat,  264 
rheumatic  fever,  134,  235,  287 


330 


INDEX 


RHEUMATIC      GOUT       (RHEUMATIC 

ARTHRITIS),    238 
RHEUMATISM,    234 

rheumatism,   198,   203,   228,  244, 
274,  305 

RHEUMATISM,    CHRONIC,    236 

rhubarb  pills,  in  medicine  chest, 

187,  189 
rhubarb  and  soda,   in  red  gum, 

234 

rhubarb,  258 
RICKETS,  239 
rickets,  207 
ringworm,  213,  257 

RINGWORM.       (  See  SKIN  DISEASES  ) 

Robinson's     Barley    Water,     for 

baldness,  21 

Rochelle  salts,  in  fever,  110 
rose  cold,  130 
roundworm,  317 
rum,  amount  of  alcohol  in,  25 
rupture,  302 

RUPTURE.        (See  HERNIA) 

Russian  baths,  214 

Saint  Vitus's  dance,   116,  240 
sal  hepatica,  69 
salicin,  for  rheumatism,  235 
salicylate  of  soda,  for  cramps,  7, 

239 

salicylate  treatment,  235 
salicylates,  in  fevers,  110 
saline  cathartics,  110 
saline  purges,  in  pregnancy,  227 

SALISBURY    TREATMENT,    The,    240 

Salisbury  treatment   for   fat,   67 
salol,    for    gallstones,    117,    187, 

190 

salt  water  baths,  214 
salts,  223 
sal   volatile,    in    medicine    chest, 

187 

sanitas  fluid,  246 
sarcoma,  292 
sardines,      17,      64.      (See     also 

DIETS) 
scabs,  253 
scales  (see  MEDICINE  CHEST), 

186 

scalp  diseases,  256 
scarlatina,  253,  287 

SCARLET      FEVER       (SCARLATINA), 

242 


scarlet  fever,  194,  248,  263 

SCIATICA,  243 

sciatica,  234 

scratching,  202 

screens,  114 

SCROFULA,  244 

scrofula,  15,  216 

scrotum,  the,  146,  301,  308 

SCURF,  245 

scurfiness  of  scalp,  257 

SCURVY,  246 

sea  air,  50 

sea-kale,  80 

SEASICKNESS,  247 

secondary  syphilis,  277 
Seidlitz  powders,  3;  230,  243 

SELF-DOCTORING,   247 

senna,  in  medicine  chest,  20,  187, 

218,  230,  317 

senna  mixture,  for  worms,  317 
septicaemia,  196 
serums,  221 

SEWAGE  DISPOSAL,   248 

sexual  excesses,  149,  298 

sex  hygiene,  151,  216 

sexual  power,  loss  of  in  diabetes, 

80;   varicocele,  301 
shampoo,  128 
shaving  brushes,  126 
shellfish,     64,     202.      (See     also 

DIETS ) 

shingles,  143 
shoes,  66 
silver  nitrate,  for  ophthalmia,  7, 

z!3 
SIMPLE  LIFE,  The,  250 

SINS  AGAINST  HEALTH — HYGIENIC 
MISDEMEANORS,  251 

Six    hundred    and    six     ("606"), 

280 
skin,  192,  212 

SKIN    DISEASES,    252 

SLEEP,    HINTS    ON   OBTAINING,    259 

sleeping  draughts,  260 

SLEEPLESSNESS,    260 

sleeplessness,  169 

SMALLPOX,  262 

smallpox,  232,  300 

smelling  salts,  187 

smoking,  252,  284 

soap,  dry,   for  feet,  29;   eczema, 

97;  hang  nails,  130 
Social  evil,  the,  305 


INDEX 


331 


sodium  phosphate,  69;   for  gall- 
stones, 117 

sodium  salicylate,  178 
softening  of  the  brain,  305 

SORE   THROAT,    263 

sore  throat  in  syphilis,  278 
sorrel,  223 
sour  stomach,  2 
Spanish  onions,  69 
SPECIALISTS,  264 

SPECTACLES    AND    FAILING    SIGHT, 

265 

SPINAL      CURVATURE  DEFORMED 

BACK,    266 

spiritus     alkalinus     saponis,     in 

scurf,  246 

spleen,  in  rickets,  240 
splint,  32 

sponge,  avoid  in  surgery,  296 
SPRAINS,  268 
SQUINTING,  268 

STAMMERING,   269 

Standard  floor  dressing,  49 
starch,     in     diabetes,     80.      (See 

also  DIETS) 
starch  poultice,  226 
starchy    foods,    not    for    infants, 

111.     (See  DIETS) 
Stavesacre  ointment,  166 
stays  (corsets),  227 
steak,  raw,  for  black  eye,  27 
steam  heat,  137 
sterile  gauge,  29 
sterno-mastoid  muscle,  318 
stethoscope,  the,  135 
stewed  fruits,  69.      (See  DIETS) 
still  births,  305 
stomach,  the,  9,  213,  215 

STOMACH  DISEASES,   270 

stomach  pump,  improvised,  98 

STONE  IN   THE  BLADDER,   272 

stone,  298,  299 
stoves,  138 
stricture,  122,  299 
stramonium,  for  asthma,  17 
stroke,  apoplectic,  12 

STRONG,    HOW   TO   BECOME,    273 

struma,  245 

STRUMS.     (See  SCROFULA) 

STUN.       (See      CONCUSSION      OF 

BRAIN ) 
STYES,   274 


suckling,    too    long,    198.      (See 

PREGNANCY) 

sugar,  80.     (See  also  DIETS) 

sugar  of  lead,  223 

sulphate  of  magnesia,  for  giddi- 
ness, 119 

sulphate  of  soda,  for  erythema, 
256 

sulphate  of  sodium,  230 

sulphate  of  zinc,  for  sore  throat, 
264 

sulphide  of  calcium,  31 

sulphonal,  217 

sulphur,  as  disinfectant,  86 

sulphur  bath,  formula  for,  23 

sulphur  ointment,  166 

sulphuric  acid,  223 

SUMMER  HOLIDAYS,    274 

sunlight,  172 

SUNSTROKE.       (See   HEATSTROKE) 

suprarenal  extract,  131 
suprarenalin,  for  bleeding,  224 
SWEATING.     (See  PERSPIRATION) 
sweets,  236.     (See  DIETS) 
swimming,  214 
SYPHILIS   (The  "BAD  DISORDER"), 

275 
syphilis,    9,    11,    118,    120,    162, 

176,  189,  198,  203,  211,  216, 

228,  239,  244,  305 
syringes,  for  deafness,  74 
syringing,  for  ears,  94 

table-rapping,  181 

tablespoonfuls,  186 

taller.,  how  to  grow,  28*0 

tamarinds,  230 

tannic  acid,  for  cracked  nipples, 

71 

tannin,  for  sore  throat,  263 
tapeworm,  15,  316 
tapioca,  69.      (See  DIETS) 
tar  ointment,  229 
tar  water,  for  colds,  34 

TATTOO   MARKS,  280 

tea,     25,     236,     252.      (See    also 

DIETS) 

teaspoonfuls,  186 
tea  drinking,  201,  252 
teeth,  care  of,  281 
teething,  112,  207 
teetotalism,  5,  6 
temperance,  5 


INDEX 


temperature  (see  FEVER),  108; 
in  health,  220 

tennis,  273 

tertiary  syphilis,  278 

testicles,  142;  in  hydrocele,  146; 
in  mumps,  200;  in  syphilis, 
278;  one  sufficient  for  pro- 
creation, 302 

TETANUS  (LOCK-JAW),  283 

thermic  fever,  140 

thermometer  ( see  MEDICINE 
CHEST),  186,  188 

Thompson,  Sir  Henry,  194,  305 

thread  worm,  317 

throat,  242.  (See  also  DIPHTHE- 
RIA, SCARLET  FEVER,  SYPH- 
ILIS) 

thrombosis,  221 

thymol  ointment,  for  stings,  26 

thyroid     gland     of     sheep,     for 

goiter,  121 
thyroid,  229 
tight   lacing,    a   cause   of   death, 

75 

tinned  foods,  64 
TOBACCO:    OUGHT  WE  TO   SMOKE 

IT?,  284 
tobacco,  204 
toe-nail  ingrowing,  285 

TONGUE,    DISEASES    OF,    286 

tongue,     the,     in     scarlet    fever, 

242 

tonsils,  242 
tonsilitis,  264 
TOO  FAT  (see  CORPULENCE),  287 

TOOTHACHE,    287 

toothbrush,  282 
trachoma,  217 

TRADE   DISEASES,    288 

trade  eruptions,  231 

TRAINING,   289 
treacle,  69,  218 
triplex,  69 
trusses,  142,  147 

TUBERCLE,    291 

tubercle  bacilli,  112 
tuberculosis,   162,   194,   196,  248, 

267 

tumor,  299 
TUMOR,  292 
Turkey  figs,  69 
Turkish  baths,  214 
turnips,  in  diabetes,  80 


turnip  poultice,  264 
turpentine,  for  bleeding,  225;  in 
psoriasis,  229 

TYPHOID   FEVER,    292 

typhoid  fever,  112,  162,  194,  196, 

209,  248,  287,  312 
typhoid  germs,  112 

ulcer  of  the  stomach,  272 

ULCERS,  294 

umbilical  hernia,  140 

Unna,  Professor,  97 

Unna's  method  for  ulcers,  296 

urethra,  the,  121 

uric  acid,  240 

URINARY  TROUBLES,   298 

urine,   quantities   per   day,    168; 

analysis  in   pregnancy,   227, 

273 

urotropin,  for  gallstones,  117 
urticaria,  201 

VACCINATION,    300 

vaccination,  111 

vaccine  treatment  for  boils,  31; 

for  consumption,  63 
vacuum  cleaning,  49 
valerianate  of  zinc,  133 

VARICELLA,    301 

varicocele,  142 

VARICOCELE,    301 

varicose  ulcer,  297 

VARICOSE  ULCER,   303 

varicose  veins,  217 

VARICOSE  VEINS,    303 

varioloid,  262 

vaseline,  27,  229 

vegetables,    69,     83,    236.      (See 

also  DIET) 
vegetarian  diet,  229 

VEGETARIANISM,    303 

venereal  disease,  263,  275 

VENEREAL  DISEASES,   305 
VENTILATION,   306 

ventral  hernia,  141 

veratrine  ointment,  207 

vermin,  171 

vertigo   (see  GIDDINESS),  118 

vesicle,  253 

vinegar,   for  black   eye,   27;    not 

for  consumptives,  64 
vinegar  and  water,  for  lice,  171 
vomiting,  153,  223 


INDEX 


333 


Walker-Gordon  pasteurizer,  155 
wall  plaster,  223 
WARTS,  308 

WATER,    309 

WATER  ON   THE  BRAIN,   312 

water  brash,  152 

WATER    BRASH,    311 
WATER   CRESS,    312 

water,  for  sleeplessness,  259 
waterproof  sheet,  186 

WATER   PURIFICATION,    311 

weights,  in  medicine  chest,  186 

WEIR-MITCHELL  TREATMENT,    312 

Walsbach,  173 

WENS,  312 

Westcott,    Martyn,    remedy    for 

sleeplessness,  259 
wheals,  253 
whiskey,  25,  223,  227 
white  arsenic,  222 
WHITE  LEG,  312 
white  mixture,  230 
white  swelling,  313 
•whitewash,  86,  223 
whiting,  223 


WHITLOW,  313 
WHOOPING  COUGH,  314 
wholemeal  bread,  69 
wine,  216.     (See  also  DIETS) 

WINTER   COUGH,    316 

Winter,  Doctor,  153 

womb,  diseases  of  in  miscarriage, 

198;  polypus,  225 
wood  ashes,  as  disinfectant,  249 
WORMS,  316 
worms,  15,  207,  269 

WRY-NECK,    318 

X-ray,   in   diagnosis,   33;    not   a 
cure  for  cancer,  38 

yellow  fever,  198 
Yeo's   method,    whooping   cough, 
315 


zinc  lotion,  for  black  eye,  27 
zinc  ointment,  144,  187,  202 
zinc  oxide,  for  trusses,  142 
zinc  sulphate,  187,  189,  200 


YB  79659 


